Clinical Investigation
Left Ventricular Function
Mitral Annular Plane Systolic Excursion as a Surrogate for Left Ventricular Ejection Fraction

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Background

Assessing left ventricular function is a common indication for echocardiography. It generally requires expert echocardiographer estimation and is somewhat subjective and prone to reader discordance. Mitral annular plane systolic excursion (MAPSE) has been suggested as a surrogate measurement for left ventricular function. The aim of this study was to examine the accuracy of MAPSE for predicting left ventricular ejection fraction (EF) on the basis of a large cohort of consecutive echocardiograms.

Methods

The study design was a retrospective analysis of 600 two-dimensional echocardiographic studies performed in a single laboratory. MAPSE measurement was performed by an untrained observer and compared with the EF as determined by an expert echocardiographer. The first 300 studies served as a calibration cohort to establish an algorithm for predicting EF on the basis of MAPSE measurement. The following 300 studies served as a verification cohort to test the accuracy of the established algorithm.

Results

Using the first 300 studies, an algorithm was developed to predict EF. Cutoff values for normal EF (≥11 mm for women and ≥13 mm for men) and severely reduced EF (<6 mm for men and women) were identified. For the intermediate-range MAPSE values, a gender-specific regression equation was calculated to generate a predicted EF. Using this algorithm, predicted EFs were determined for the 300 patients in the verification cohort. By comparing the predicted EF and the expert-reported EF, positive and negative predictive values, sensitivity (73%–92%), specificity (81%–100%), and accuracy (82%–86%) of MAPSE for predicting EF were calculated.

Conclusions

MAPSE measurement by an untrained observer was found to be a highly accurate predictor of EF.

Section snippets

Methods

The study design was a retrospective analysis of echocardiograms obtained for clinical indications. Six hundred consecutive two-dimensional (2D) echocardiographic studies done in the echocardiography laboratory at Lenox Hill Hospital (an urban teaching hospital) were included in our study (Philips iE33 xMATRIX Ultrasound System; Philips Medical Systems, Andover, MA). M-mode echocardiography through the mitral valve annulus, from the apical four-chamber view at both the septal and lateral

Calibration Cohort

Three hundred consecutive 2D echocardiographic studies were reviewed by the medical student, and MAPSE values were measured in all 300 patients. No patients were excluded from data analysis. Data recorded for each patient are listed in Table 1. Of all the patient characteristics documented, gender had the greatest correlation with EF. Although MAPSE values were similar between genders, we found that on average, a given MAPSE value correlated with a higher EF in women. Given this observation,

Discussion

Our results demonstrate that MAPSE values, measured by an untrained reader, are accurate predictors of left ventricular EF. We verified this in a large cohort of consecutive patients (600) with no exclusion criteria, representative of what might be seen in any busy echocardiography laboratory. This is the largest study thus far to correlate MAPSE and EF.

We created a simple algorithm for the prediction of EF on the basis of MAPSE values; high and low cutoff values were defined to help quickly

Conclusions

Our work has determined that MAPSE, measured by an untrained observer, is a viable surrogate for expert determined left ventricular EF. Our findings suggest that gender significantly affects this correlation. We have established upper and lower thresholds for normal and severely reduced EFs for each gender and a simple gender-specific equation to calculate EF from intermediate MAPSE values. We believe that MAPSE should be routinely acquired in all echocardiographic studies and used as a

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