5 years ago

Relation of the Mitral Annular Plane Systolic Excursion (MAPSE) to Risk for Intervention among Initially Asymptomatic Patients with Aortic Stenosis and Preserved Systolic Function

Aortic valve intervention (AVI) in patients with severe aortic stenosis (AS) and preserved left ventricular (LV) ejection fraction (EF) is controversial. Mitral annular plane systolic excursion (MAPSE) is an easily acquired metric of LV longitudinal shortening. We sought to investigate if an asymptomatic decline in MAPSE preceded the need for AVI in asymptomatic patients with AS and preserved LVEF. In this retrospective cohort study, we identified 205 consecutive patients (56% male; 73±11 years) with at least moderate AS and normal LVEF who underwent serial outpatient transthoracic echocardiography (TTE) from 2006 to 2013. Apical TTE images were reviewed and (average of septal, lateral, anterior and inferior) MAPSE measured. We examined the association of change in MAPSE with aortic valve area (AVA) and LVEF over time and used time-varying Cox models to examine the risk of AVI. MAPSE correlated with AVA (Spearman r=0.18; p=0.02) and declined with subsequent TTE, while LVEF was maintained. For each 1 mm reduction in MAPSE, the age- and sex-adjusted hazard ratio (HR) for AVI was 1.15 (95% CI=1.01-1.31, p=0.04). A MAPSE decline of >2 mm/TTE was significantly associated with an increased risk for AVI, with adjusted hazard ratio of 1.95 (95% CI=1.04-3.66, p=0.04), while a MAPSE decline of >1.5 mm/year trended toward association with increased risk of AVI (HR 1.61, 95% CI=0.95-2.74, p=0.08). In conclusion, among asymptomatic patients with at least moderate AS and preserved LVEF, an asymptomatic decline in MAPSE was associated with the clinical need for AVI despite ongoing preservation of LVEF.

Publisher URL: www.sciencedirect.com/science

DOI: S0002914917313917

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