The following is a summary of “Focused cardiac ultrasound with mitral annular plane systolic excursion (MAPSE) detection of left ventricular dysfunction,” published in the June 2023 issue of Emergency Medicine by Schick, et al.

For a prospective observational single-center study, researchers sought to determine whether the measurement of mitral annular plane systolic excursion (MAPSE) by emergency physicians (EPs) can accurately predict left ventricular ejection fraction (LVEF) <50% as assessed by a comprehensive echocardiogram (CE).

A convenience sample of patients with possible decompensated heart failure underwent a focused cardiac ultrasound (FOCUS) performed by EPs. The FOCUS included standard cardiac views to estimate LVEF, MAPSE, and E-point septal separation (EPSS). Abnormal MAPSE was defined as <8 mm, and abnormal EPSS was defined as >10 mm. The primary outcome assessed was the ability of an abnormal MAPSE to predict an LVEF <50% on CE. MAPSE was also compared to EP-estimated LVEF and EPSS. Inter-rater reliability was evaluated by two investigators independently performing the blinded review.

A total of 61 subjects were enrolled, with 24 (39%) having an LVEF <50% on CE. MAPSE <8 mm had a sensitivity of 42% (95% CI 22-63), a specificity of 89% (95% CI 75-97), and an accuracy of 71% for detecting LVEF <50%. MAPSE demonstrated lower sensitivity compared to EPSS (79% sensitivity [95% CI 58-93] and 76% specificity [95% CI 59-88]) and higher specificity compared to estimated LVEF (100% sensitivity [95% CI 86-100] and 59% specificity [95% CI 42-75]). The positive predictive value (PPV) and negative predictive value (NPV) for MAPSE were 71% (95% CI 47-88) and 70% (95% CI 62-77), respectively. The receiver operating characteristic (ROC) for MAPSE <8 mm was 0.79 (95% CI 0.68-0.9). Inter-rater reliability for MAPSE measurement was 96%.

In the exploratory study, the measurement of MAPSE by EPs showed good inter-rater reliability and was easy to perform with minimal training. MAPSE <8 mm had a moderate predictive value for LVEF <50% on CE and was more specific for reduced LVEF compared to qualitative assessment. Further studies on a larger scale are needed to validate the findings.

Source: sciencedirect.com/science/article/abs/pii/S0735675723001341