MITRAL ANNULAR PLANE SYSTOLIC EXCURSION (MAPSE)

MITRAL ANNULAR PLANE SYSTOLIC EXCURSION (MAPSE) UNDERESTIMATES LEFT VENTRICLE SYSTOLIC FUNCTION IN PATIENTS WITH LEFT VENTRICLE HYPERTROPHY

Abstract

Background and Objectives: Assessment of left ventricle function is the single
most common indication for transthoracic echocardiogram. Out of different indicators of LV
function, ejection fraction is the most validated one. MAPSE has promised recently to be a reliable
and easily obtainable indicator for LV function even in inexperienced hands but its value in case
of left ventricle hypertrophy (LVH) is questionable. Study Design: Cross-sectional comparative
study. Setting: Rehmatul-lil-Alameen Institute of Cardiology, Lahore. Period: January 2015
and March 2015. Methods: 100 consecutive patients presenting for echocardiography at
Rehmatul-lil-Alameen Institute of Cardiology, Lahore. Patients were divided into two groups on
the basis of presence of left ventricle hypertrophy (LVMI >115 g/m2 in males and > 95 g/m2
in females) and further subdivided according to LVEF into those with preserved (EF>55%) and
depressed EF (EF<55%). EF was calculated by visual quantification (eyeballing). MAPSE was
measured using M-mode at all four mitral annular sites-medial, lateral, anterior and posterior
and values averaged. Results: Among 100 patients; 66(66%) were without LVH while 34(34%)
were having LVH. Without LVH group had 43 (65%) patients with preserved LVEF (EF>55%)
while 23 (35%) had depressed LVEF (EF>55%). In LVH group 22 (64.7%) had preserved
LVEF while 12 (35.3%) had depressed LVEF. Mean EF (%), without LVH and preserved LVEF
(61.6±3.6), LVH with preserved LVEF (61.9±3.6). Mean EF (%); without LVH and depressed
LVEF (41.1±6.4), LVH with depressed LVEF (42.9±5.4), p=0.663. Mean MAPSE score (mm);
without LVH with preserved LVEF (13.2±1.7), LVH with preserved LVEF (10.6±0.9), p<0.001.
Mean MAPSE score (mm); without LVH and depressed LVEF (9.17±0.9), LVH with depressed
LVEF (7.4±1.5), p=0.002. Mann Whitney U test was applied to compare the MAPSE score of
groups and it showed statistically significant difference in MAPSE score of patients with and
without left ventricle hypertrophy with values much lower in the presence of LVH. Conclusion:
Statistically significant difference exists in values of MAPSE in patients with and without left
ventricle hypertrophy irrespective of LV function.