الفهرس 
Left ventricular systolic dysfunctionOnly 14 pages are availabe for public view
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Abstract
Accurate assessment of left ventricular (LV) ejection
fraction by two-dimensional transthoracic echocardiography (TTE) is time-intensive and limited by
poor image quality, because of its dependence on endocardial tracing.
The recognition of these limitations has led to the development of alternative echocardiographic
methods for the assessment of LV systolic function. One proposed method involves the use of mitral
annular displacement (MAD), which is fast and does not depend on endocardial definition and thus
can be easily performed in the majority of patients quiet independent of imaging quality.
(3,112,134)
Thus, use of MAPSE measurement is helpful to evaluate LV systolic function in case of poor
sonographic windows. MAPSE has been proposed as a well-established clinically useful
echocardiographic parameter for the assessment of LV longitudinal function and correlates
with global systolic function of the LV. Previous clinical studies showed that, MAPSE, which
reflects the mitral ring displacement at systole, can be used to assess cardiac global longitudinal
function and is a sensitive parameter to define slight abnormalities in various patients
with cardiovascular diseases at early stage
where longitudinal function is affected before other
components of the heart. (84,85)
Different studies tried to generate formula to predict ejection fraction from measuring MAPSE which
corresponds to the systolic function of left ventricle either related to age, body surface area in
pediatrics or gender.
In 2012 Matos et al. generated gender specific formula to calculate ejection fraction using MAPSE
where EF equals for men= 4.8 x MAPSE (mm) + 5.8 and for women= 4.2 x MAPSE (mm) + 20 compared with
expert eyeball echocardiographer. (133)
This study showed that MAPSE is an easy applicable method to measure with no significant
intraobserver and interobserver variability.
In this study which showed that mean value of average
MAPSE was < 6 mm and mean value of lateral MAPSE was <
8 mm and mean value of med MAPSE was < 5 mm was linked with reduced values of ejection fraction (<
50%).
In this study there was high significant correlation between ejection fraction measured using
MAPSE in the gender specific formula generated by Matos et al. and ejection fraction measured by
standard methods of echocardiography
(M-mode, Simpson’s method, Eye ball method) in total
patients and in male patients while there was non-significant correlation in ejection fraction
measured by MAPSE compared to ejection fraction measured by M-mode, eye ball and Simpson’s in
female patients.
This study showed that female predicted ejection fractions using MAPSE formula
generated by Matos et al. gave higher mean values than the mean values of ejection fraction
measured by M-mode, Simpson’s method and eye ball.
Using the patient population statistical data included in this study, another corresponding formula
generated for both males and females to calculate ejection fraction by MAPSE for trial to reach
a more accurate and reliable formula for predicting ejection fraction and for males predicted
formula was; EF= 12.092 + 2.95 X average MAPSE (mm) and for females predicted formula was; EF
= 26.334 + 0.944 X average MAPSE (mm).
This study was conducted on patients with LV dysfunction due to different etiologies and both
patients with ischemic or non ischemic LV dysfunction were enrolled in this study. MAPSE
measurement is known to have less accurate readings in patients who have Regional wall
motion
abnormalities involving the base or mid-ventricle which would likely cause reduced annular motion
locally and therefore may affect the estimation of overall EF. It should be noted that the wall
motion abnormalities which involve the apex rather than the base of the heart will be less
affecting the MAPSE estimation. Therefore, the results of this study cannot be extrapolated to
patients with regional wall motion abnormalities involving the base and mid-ventricle.
Similarly, we did not study patients with paradoxical septal wall motion
which might affect the septal MAPSE (medial MAPSE). (137)
In the End Although MAPSE has some limitations but it has a lot of clinical applications and
implications in many cardiovascular diseases as hypertensive heart diseases, coronary artery
diseases, aortic stenosis and heart failure. Also MAPSE is used as a tool or method to assess for
prognosis and follow up in patients with myocardial infarction and for
mortality follow up in patients with cardiomyopathy. (127,128,129)