Mitral annular plane systolic excursion on exercise: a simple diagnostic tool for heart failure with preserved ejection fraction

Aims 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. Methods and 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 VO2 max (18.6+/-5.2 mL/min/kg) and 36 control subjects (LVEF = 62 +/- 7%, VO2 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. Conclusion 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.