Relation of the Mitral Annular Plane Systolic Excursion to Risk for Intervention in Initially Asymptomatic Patients With Aortic Stenosis and Preserved Systolic Function

Matos, Jason; Kiss, Joshua E.; Locke, Andrew H.; Goldberg, Randal I.; Mukamal, Kenneth J.; Manning, Warren J.

doi:10.1016/j.amjcard.2017.08.021

Cited by 8 publications

(10 citation statements)

References 9 publications

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“…In a comparison between the two groups of patients, RVAVPD was significantly lower in patients with the RV in the systemic position. This is consistent with findings in LV hypertrophy where displacement of the mitral ring (MAPSE) is reduced [ 26 ] and the correlation between LVEF and MAPSE is lost [ 27 ]. A reduction in RVAVPD could be reflected in longitudinal strain reduction, as found here.…”

Section: Discussionsupporting

confidence: 91%

Afterload dependence of right ventricular myocardial deformation: A comparison between tetralogy of Fallot and atrially corrected transposition of the great arteries in adult patients

Trzebiatowska-Krzynska

Swahn

Wallby

et al. 2018

PLoS ONE

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BackgroundPrior studies suggested that myocardial deformation is superior to conventional measures for assessing ventricular function. This study aimed to evaluate right ventricular (RV) myocardial deformation in response to increased afterload. Patients with the RV in the systemic position were compared with patients with the RV in the sub-pulmonic position with normal or only slightly elevated systolic right ventricular pressure. Correlations between global longitudinal strain (GLS), radial strain, atrioventricular plane displacement (AVPD), and exercise capacity were evaluated.Methods44 patients with congenital heart defect were enrolled in the study. The control group consisted of seven healthy volunteers. All patients underwent cardiovascular magnetic resonance (CMR) and cardiopulmonary exercise testing. We assessed biventricular myocardial function using CMR based feature tracking and compared the results to anatomic volumes.ResultsStrain analysis and displacement measurements were feasible in all participants. RVGLS and RVAVPD were reduced in both study groups compared to the control group (p<0.001). Left ventricular (LV) radial strain was significantly lower in patients with a systemic RV than in those with a subpulmonic RV and lower than in controls (p<0.001). Both LVAVPD and RVAVPD were significantly depressed in patients compared to controls (p<0.05). RVAVPD was more depressed in patients with a high systolic RV pressure than in those with normal RV pressure (p<0.001). RVAVPD did not correlate with exercise capacity in either study group. Exercise capacity in both patient groups was depressed to levels reported in previous studies, and did not correlate with RVGLS.ConclusionsBoth study groups had abnormal myocardial deformation and increased RV volumes. RVGLS in patients was lower than in controls, confirming the effect of increased afterload on myocardial performance.

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Section: Discussionsupporting

confidence: 91%

Afterload dependence of right ventricular myocardial deformation: A comparison between tetralogy of Fallot and atrially corrected transposition of the great arteries in adult patients

Trzebiatowska-Krzynska

Swahn

Wallby

et al. 2018

PLoS ONE

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“…Finally, MAPSE was shown to be a relevant prognostic index. In asymptomatic patients with aortic stenosis and normal EF, an asymptomatic decrease in MAPSE was associated with the clinical need for aortic valve intervention despite ongoing preservation of LVEF [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Intraobserver and interobserver reproducibility of M-mode and B-mode acquired mitral annular plane systolic excursion (MAPSE) and its dependency on echocardiographic image quality in children

et al. 2018

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BackgroundMitral annular plane systolic excursion (MAPSE) is an increasingly used echocardiography technique to assess left ventricular (LV) function. However, reproducibility and dependence on echocardiographic image quality for MAPSE in pediatric patients have not been studied to date.MethodsWe analyzed 284 transthoracic echocardiograms performed on consecutive normotensive children without structural heart disease (mean age 12.6±3.1 years, 50.4% female). B-mode and M-mode derived MAPSE measurements were performed and analyzed regarding inter- and intraobserver reliability and the influence of echocardiographic image quality.ResultsOverall, MAPSE measurements were highly reproducible with only minor bias. Both inter- and intraobserver reliability were significantly better for M-mode derived MAPSE (p<0.001). Echocardiographic image quality did not significantly influence M-mode MAPSE reproducibility (p>0.235). In contrast, B-mode lateral MAPSE was significantly better reproducible in optimal image quality (-0.07±1.04) when compared to suboptimal echocardiographic images (0.42±1.59, p<0.001). Moreover, poor quality images yielded significantly lower M-mode MAPSE values (14.3±2 mm) than near-optimal (15.2±1.9 mm, p<0.001) or optimal images (15.1±2.2 mm, p = 0.006).ConclusionEchocardiographic image quality essentially has a negligible effect on MAPSE reproducibility and measurements. Consequently, MAPSE is a robust echocardiographic parameter with convincing reproducibility for the assessment of LV function in children—even in patients with substandard imaging conditions.

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“…In line with previous findings from our group [ 15 ] and others [ 16 ], the present study results demonstrate that reduced MAPSE is suggestive of TS-LGAS in patients with LVEF > 50%. A previous study also showed that MAPSE correlated with aortic valve area (Spearman r = 0.18, P = 0.02) in 205 asymptomatic AS patients with LVEF ≥ 50% [ 17 ]. In another study, Rydberg and colleagues found that left atrioventricular plane displacement (MAPSE), but not left ventricular ejection fraction, was influenced by the degree of aortic stenosis [ 16 ].…”

Section: Discussionmentioning

confidence: 85%

Value of low-dose dobutamine stress echocardiography on defining true severe low gradient aortic stenosis in patients with preserved left ventricular ejection fraction

Liú

Liebner

et al. 2018

Int J Cardiovasc Imaging

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Low-dose dobutamine stress echocardiography (DSE) is a valuable tool to distinguish true-severe (TS) from pseudo-severe (PS) low gradient aortic valve stenosis (LGAS) in patients with reduced left ventricular ejection fraction (LVEF). However, only scanty studies reported the clinical utility of DSE in differentiating TS-LGAS patients with preserved LVEF. We investigated the clinical utility of DSE in LGAS patients with preserved LVEF and the echocardiographic determinants suggestive of TS-LGAS. 130 consecutive LGAS patients [indexed aortic valve area (AVA) ≤ 0.6cm2/m2 and mean trans-aortic pressure gradient (PGmean) < 40mmHg] with preserved (≥ 50%, n = 63) and reduced (< 50%, n = 67) LVEF were included. DSE defined TS-LGAS (projected AVA ≤ 1 cm2) in 61.2% patients with reduced LVEF and in 68.3% patients with preserved LVEF. Multivariate logistic regression analysis showed that baseline AVA was an independent determinant of TS-LGAS both in LVEF ≥ 50% (OR 0.45, P = 0.004) and LVEF < 50% groups (OR 0.55, P = 0.005). Reduced septal and lateral mitral annular plane systolic excursion (MAPSE, OR 0.72 and 0.75, P = 0.013 and 0.016) and septal TDI-s´ were significantly associated with TS-LGAS in patients with LVEF ≥ 50%. Higher systolic pulmonary artery pressure (SPAP, OR 1.43, P = 0.045) was associated with TS-LGAS in patients with LVEF < 50%. DSE is useful to define TS-LGAS also in patients with preserved LVEF. Lower baseline AVA values are linked with TS-LGAS in both patients with reduced and preserved LVEF. Reduced MAPSE and septal TDI-s´ are suggestive of TS-LGAS in patients with preserved LVEF, while higher SPAP is associated with TS-LGAS in patients with reduced LVEF.Electronic supplementary materialThe online version of this article (10.1007/s10554-018-1416-z) contains supplementary material, which is available to authorized users.

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Relation of the Mitral Annular Plane Systolic Excursion to Risk for Intervention in Initially Asymptomatic Patients With Aortic Stenosis and Preserved Systolic Function

Cited by 8 publications

References 9 publications

Afterload dependence of right ventricular myocardial deformation: A comparison between tetralogy of Fallot and atrially corrected transposition of the great arteries in adult patients

Afterload dependence of right ventricular myocardial deformation: A comparison between tetralogy of Fallot and atrially corrected transposition of the great arteries in adult patients

Intraobserver and interobserver reproducibility of M-mode and B-mode acquired mitral annular plane systolic excursion (MAPSE) and its dependency on echocardiographic image quality in children

Value of low-dose dobutamine stress echocardiography on defining true severe low gradient aortic stenosis in patients with preserved left ventricular ejection fraction

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