Mitral Annulus Pre-Systolic Excursion (MAPSE) Versus Modified Simpson’s Method for Ejection Fraction Estimation in Patients with Acute Coronary Syndrome
Akif Ahamad Baig1, Rajendra Betham1, Srikanth Nathani1
1Department of Cardiology, Guntur Medical College, Guntur, Andhra Pradesh, India.
ABSTRACT
Objectives: Evaluating left ventricle (LV) systolic function is pivotal in cardiac assessment, primarily relying on the left ventricular ejection fraction (LVEF) calculated through the modified Simpson’s method. However, challenges arise in accurately determining LVEF, especially in patients with acute coronary syndrome, where difficulty in visualizing the blood tissue interface can lead to inaccuracies. Mitral annular plane systolic excursion (MAPSE), which evaluates longitudinal function of LV has shown promise in detecting subtle myocardial abnormalities, particularly in patients with preserved ejection fraction (EF).
Materials and Methods: The study included three groups of patients based on EF measurement using modified Simpson’s method: Group A with EF <50%, Group B with EF >50%, and Group C as healthy controls. In each group, MAPSE and EF derived from MAPSE formula were calculated: 4.8 × MAPSE (mm) + 5.8 in males, 4.2 × MAPSE (mm) + 2.0 in females. Statistical analyses were conducted to assess the agreement and potential differences between the two methods within each group.
Results: The mean age of study population was 55.63 ± 9.21 years in Group A, 54.79 ± 9.82 years in Group B, and 55.10 ± 8.79 years in Group C. In Group A, mean EF measured through modified Simpson’s formula was 37.79 ± 5.38, whereas mean EF measured through MAPSE was 37.95 ± 5.32. There was no statistical difference among EF calculation through Simpson’s method or MAPSE method. (P = 0.8293). In Group B, Mean EF calculated through Simpson method was 56.24 ± 3.12 whereas with MAPSE method was 52.31 ± 4.26. There was found to be a statistical difference in EF calculation by both of this method in patients with EF>50% (P < 0.0001). In Group C, mean EF calculated through Simpson’s method was 64.23 ± 5.21 and through MAPSE was 64.99 ± 4.85, respectively. There was no statistical difference between this two methods in terms of EF calculation (P = 0.2812).
Conclusion: EF assessment using the traditional modified Simpson’s method and MAPSE demonstrated a strong correlation in patients with EF <50% and controls. However, in patients with EF >50%, MAPSE revealed subendocardial dysfunction undetected by the Simpson method, highlighting MAPSE’s value in identifying subtle myocardial abnormalities.
Keywords: Mitral annular plane systolic excursion, Modified Simpson’s, Ejection fraction, Left ventricle, Acute coronary syndrome
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