Measurement of Mitral Annular Plane Systolic Excursion to Estimate Left Ventricular Ejection Fraction in Patients with Left Ventricular Systolic Dysfunction

Backgrounds and Aims: Left Ventricular Ejection Fraction (LVEF) serves as an important prognostic tool for managing patients with heart failure. Mitral annular plane systolic excursion (MAPSE) can be used for the calculation of LVEF as an easy, reproducible, reliable and cost-effective method.

Methods: This was a hospital-based observational study. Patients, above 18, from OPD and wards in Bir Hospital and Shahid Gangalal National Heart Centre referred for echocardiographic assessment, who were found to have systolic dysfunction (LVEF < 50%), were enrolled in the study. Patients with primary valvular disease, congenital heart disease, any type of arrhythmia, acute coronary syndrome, hemodynamic instability and history of recent (≤6weeks) cardioversion were excluded from the study. Mean of lateral and medial MAPSE values were taken; and LVEF derived from biplane apical (2- and 4-chamber) views using the modified Simpson’ s rule algorithm was used in the study for comparison.

Results: 155 patients were enrolled in the study, out of which, 81 were males and 74 were females. Gender-wise regression analysis between LVEF-Simpson and MAPSE-Mean showed a strong positive correlation (R2 = 0.614) for males and a fair positive correlation (R2 = 0.310) for females. In both, the regression model was significant (p < 0.05). From the Regression analysis, the gender-specific formulae for predicted LVEF from MAPSE for our population were calculated as:

LVEF for Male = 3.6 x MAPSE + 7

LVEF for Female = 2.4 x MAPSE + 12.5

Conclusions: The use of MAPSE is helpful to calculate LV systolic function in case of poor echocardiographic windows and for non-cardiologist and novice practitioners. There is a fair correlation between LVEF derived from modified Simpson method and the average MAPSE value.