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 15 ^th century. Longitudinal LV function accounts for 60% of the total stroke volume, so MAPSE reflects the majority contribution to systolic function. 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 in accordance with the PRISMA statement. MAPSE values show 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. MAPSE correlates with both LVEF ( r =0.60 [95% confidence interval 0.49–0.70]) and global longitudinal strain ( r =0.45 [0.34–0.57]) and can act as an alternative marker of LV systolic dysfunction in patients with poor echocardiographic windows. MAPSE falls while LVEF remains preserved across a range of pathologies, allowing physicians to detect systolic impairment earlier than when using LVEF. MAPSE is also a powerful prognostic tool, outperforming LVEF and GLS in predicting adverse events in several studies. These results highlight a clinically useful and important role for MAPSE in routine cardiac imaging and care.

Highlights

• MAPSE reflects the systolic longitudinal movement of the atrioventricular valve plane, which accounts for 60% of the left ventricular stroke volume.

• MAPSE is easily and quickly attainable, shows good agreement between imaging modalities, and can be easily automated.

• MAPSE can be used to detect systolic dysfunction before left ventricular ejection fraction falls in many disease states, allowing clinicians to identify patients most at risk from progression of heart disease.

• MAPSE has an association with prognosis that is stronger than that of left ventricular ejection fraction and global longitudinal strain in several conditions.