The diagnostic and prognostic utility of mitral annular plane systolic excursion (MAPSE)- a systematic review

Movement of the mitral annulus towards the left ventricular (LV) apex during systole, termed atrioventricular plane displacement (AVPD) or mitral annular plane systolic excursion (MAPSE), was first observed by Leonardo da Vinci in the 15th century. MAPSE, a marker of longitudinal function, shows good agreement between transthoracic echocardiography and cardiac magnetic resonance imaging (CMR), and can also be measured by transesophageal echocardiography and gated cardiac computed tomography. Manual measurement is fast, simple, and less reliant on good echocardiographic image quality than left ventricular ejection fraction (LVEF) or global longitudinal strain (GLS). Also, measurement can be easily automated, reducing reporting time. However, no major imaging guidelines advise routine measurement. We present a systematic review of studies appraising the diagnostic and prognostic performance of MAPSE from PubMed, Medline and Embase until December 2024 in accordance with the PRISMA statement. Our findings demonstrate that MAPSE correlates with both LVEF (r=0.60 [95% confidence interval 0.50-0.69]) and GLS (r=0.53 [0.43-0.63]), thus showing a modest association with measures of systolic function that may be particularly useful in patients with poor echocardiographic windows. Importantly, MAPSE falls while LVEF remains preserved across a range of pathologies, allowing the detection of systolic impairment earlier than when using LVEF. MAPSE is also a powerful prognostic tool, outperforming both LVEF and GLS in predicting adverse events in several studies. Taken together, MAPSE has a clinically useful and important role worthy of integration into routine cardiac imaging and care.