Assessment of left ventricle function in aortic stenosis: mitral annular plane systolic excursion is not inferior to speckle tracking echocardiography derived global longitudinal peak strain

Abstract

Background: Early detection of left ventricle (LV) systolic dysfunction is essential for management of patients with aortic stenosis (AS). Two- dimensional speckle tracking derived global longitudinal peak strain (GLPS) is more sensitive than ejection fraction (EF) but requires good image quality and is not easily accessible. The aim of the study was to compare GLPS with traditional echocardiographic parameter- mitral annular plane systolic excursion (MAPSE) in AS.

Material and methods: In consecutive patients with moderate to severe AS and LV ejection fraction ≥ 50% standard echocardiography and two-dimensional speckle tracking echocardiography were performed. Mitral annular plane systolic excursion and global longitudinal peak strain were obtained from apical echocardiographic views.

Results: A total of 82 patients were examined, median age was 68 (60-78), 56% of them were men. There was a positive correlation between aortic valve area index (AVAI) and: MAPSE (r = 0.334, p = 0.002), MAPSE indexed for body surface area- MAPSEI (r = 0.349, p = 0.001) and GLPS (r = 0.342, p = 0.002) but not EF (r = 0.031, p = 0.782). A positive correlation was found between GLPS and MAPSE (r = 0.558, p < 0.001) and between GLPS and MAPSEI (r = 0.543, p < 0.001). All above parameters were significantly lower in symptomatic patients compared to asymptomatic subjects (GLPS: -13.82 ± 3.56 vs. -16.39 ± 3.16%, p = 0.002, MAPSE: 10.49 ± 1.91 vs. 11.95 ± 1.82 mm, p = 0.001 and MAPSEI: 5.66 (4.83-6.6) vs. 6.46 ± 0.97 mm/m2, p = 0.005).

Conclusion: Despite the development of the modern echocardiographic techniques, mitral annular plane systolic excursion can still be used as a sensitive tool to detect early longitudinal LV systolic dysfunction.

Figure 1

Measurement of the mitral annular plane systolic excursion (MAPSE). MAPSE was measured at the septal side (A) and the lateral side (B) of the atrioventricular plane by M-Mode and the average value was calculated.

Figure 2

Global and segmental longitudinal strain. The “bull-eye” presentation shows the longitudinal strain in 17 segments of the left ventricle and calculated global longitudinal peak strain (GLPS_Avg).

Figure 3

Correlations between aortic valve area index (AVAI) and parameters assessing left ventricle systolic function. MAPSE- mitral annular plane systolic excursion (A), MAPSEI- mitral annular plane systolic excursion index (B), GLPS- global longitudinal peak strain (C), EF- ejection fraction (D).

Figure 4

Correlations between global longitudinal peak strain (GLPS) and M-Mode derived parameters. MAPSE- mitral annular plane systolic excursion (A), MAPSEI- mitral annular plane systolic excursion index (B).

Figure 5

Receiver operating characteristic (ROC) curves for the prediction of symptoms. MAPSE- mitral annular plane systolic excursion, GLPS- global longitudinal peak strain, AUC- area under the curve.