title: Mitral annular plane systolic excursion on exercise: a simple diagnostic tool for heart failure with preserved ejection fraction.
abstract: OBJECTIVE
  Current guidelines for the diagnosis of heart failure with normal or preserved ejection fraction (HFpEF) are based on measurements at rest. However, in HFpEF ventricular dysfunction is more apparent on exercise. We hypothesized that Mitral annular plane systolic excursion (MAPSE) which is easy to acquire on exercise could be used to detect occult left ventricular (LV) impairment.
  
  
  RESULTS
  Cardiopulmonary exercise testing and 2D-Doppler echocardiography were performed at rest and on exercise. MAPSE was assessed by using M-mode (apical four-chamber view). Sixty-two patients with HFpEF [LV ejection fraction (LVEF)=60 ± 7%] with reduced VO(2) max (18.6 ± 5.2 mL/min/kg) and 36 control subjects (LVEF=62 ± 7%, VO(2) max 29.4 ± 4.8 mL/min/kg) were studied. MAPSE at rest was significantly lower in patients (10.9 ± 2.1 vs. 12.1 ± 2.2 mm in controls, P= 0.008) which was even more pronounced on exercise (12.0 ± 2.2 mm and 16.2 ± 2.7 mm, respectively, P< 0.001). At rest MAPSE correlated with longitudinal strain (r = 0.432, P= 0.001), peak systolic myocardial velocity (r = 0.545, P< 0.001), and early diastolic myocardial velocity (r = 0.322, P= 0.02) and on exercise with LV apical rotation (r = 0.582, P< 0.001), longitudinal strain (r = 0.589, P< 0.001), and myocardial tissue velocities (P< 0.001). The area under the receiver operating characteristic curve for MAPSE was 0.655 (confidence interval 0.540-0.770) at rest and 0.901 (confidence interval 0.835-0.967) on exercise, to differentiate between patients and controls.
  
  
  CONCLUSIONS
  Mitral annular plane systolic excursion at rest and on exercise correlates well with more sophisticated measurements of ventricular function in HFpEF patients. It is potentially a useful and easily acquired measurement, especially on exercise, for the diagnosis of HFpEF.
authors.affiliation: Department of Cardiovascular Medicine, University of Birmingham, Birmingham, UK. frauke.wenzelburger@uhns.nhs.uk
authors.forename: Frauke W G
authors.initials: FW
authors.lastname: Wenzelburger
authors.forename: Yu Ting
authors.initials: YT
authors.lastname: Tan
authors.forename: Ferrah J
authors.initials: FJ
authors.lastname: Choudhary
authors.forename: Eveline S P
authors.initials: ES
authors.lastname: Lee
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
authors.forename: John E
authors.initials: JE
authors.lastname: Sanderson
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003663:Decision Trees; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging