Clinical implication of mitral annular plane systolic excursion for patients with cardiovascular disease

Abstract

Mitral annular plane systolic excursion (MAPSE) has been suggested as a parameter for left ventricular (LV) function. This review describes the current clinical application and potential implications of routinely using MAPSE in patients with various cardiovascular diseases. Reduced MAPSE reflects impaired longitudinal function and thus provides complementary information to ejection fraction (EF), which represents the global result of both longitudinal and circumferential contraction. Reduced long-axis deformation results from dysfunctional or stressed longitudinal myofibres due to endo- (and potentially epi-) cardial ischaemia, fibrosis, or increased wall stress. In patients with aortic stenosis, reduced MAPSE is suggestive of subendocardial fibrosis. Moreover, reduced MAPSE could be used as a sensitive early marker of LV systolic dysfunction in hypertensive patients with normal EF, where compensatory increased circumferential deformation might mask the reduced longitudinal deformation. In addition, reduced MAPSE was associated with poor prognosis in patients with heart failure, atrial fibrillation and post-myocardial infarction as well as in patients with severe aortic stenosis undergoing aortic valve replacement. Despite of the routine use of newer and more refined echocardiographic technologies nowadays, such as strain-rate imaging, speckle-tracking imaging, and 3D echocardiography, the use of MAPSE measurement is still especially helpful to evaluate LV systolic function in case of poor sonographic windows, since good imaging quality is required for most of the modern echocardiographic techniques with the exception of tissue Doppler imaging.

A bal kamra korszerű echokardiográfiás vizsgálata – az M-módtól a 3D speckle-tracking képalkotásig

“…Apicalis 4 üregi nézetben (apical 4-chamber view -AP4CH) az ultrahangnyalábot a lateralis mitralis anulusra helyezve annak longitudinális mozgása az idő függ-vényében vizsgálható (normálérték: >1 cm) [2,10].…”

Long-axis fractional shortening and mitral annulus motion in dogs

“…The highest wave corresponds to end diastole, while the lowest one is obtained at end systole FUENTES, 2001). While MAM was shown to be a reliable and straightforward method to identify systolic impairment non-invasively (ALAM, 1991), it may not be useful for recognizing regional systolic dysfunction (HU et al, 2013). Also, because the cardiac apex does not exhibit significant movement along the cardiac cycle, MAM is directly related to the longitudinal systolic shortening of the left ventricle, since alterations in the long axis are likely attributable to the displacement of the mitral ring toward the apex (JONES et al, 1990).…”

“…Jones et al (1990) reported that all myocardial layers are involved in cardiac contraction and, interestingly, with systolic dysfunction, the longitudinal fibers might be the first to be impaired even while the circumferential fibers are still normal.…”

“…While the mitral ring moves toward the heart apex during cardiac systole, during diastole it pushes backward to the left atrium (JONES et al, 1990). These displacements are recorded by M-mode echocardiography and the difference in the wave amplitude is used for calculation of MAM.…”

“…While MAM was shown to be a reliable and straightforward method to identify systolic impairment non-invasively (ALAM, 1991), it may not be useful for recognizing regional systolic dysfunction (HU et al, 2013). Also, because the cardiac apex does not exhibit significant movement along the cardiac cycle, MAM is directly related to the longitudinal systolic shortening of the left ventricle, since alterations in the long axis are likely attributable to the displacement of the mitral ring toward the apex (JONES et al, 1990). In some studies, however, it has been compared with either the ejection fraction or shortening fraction, which are both dependent on the radial displacement of the myocardium.…”