Mitral annular plane systolic excursion in moderate-severe aortic stenosis, low flow and preserved systolic function

Abstract

Background: low flow (LF) (stroke volume index (SVi) <35 ml/m²) serves as a prognostic marker of aortic stenosis (AS). Longitudinal strain assessed by speckle tracking is a determinant of LF. However, this method requires an adequate ultrasound window. Mitral annular plane systolic excursion (MAPSE) functions as an alternative for longitudinal strain. Objectives: to investigate the relationship between MAPSE and LF in patients with moderate AS (MAS) or severe AS (SAS). Methods: patients with MAS (valve area <1.50 cm²) or SAS (valve area <1 cm²) and an ejection fraction ≥ 50% were evaluated. The average MAPSE was calculated utilizing the lateral and medial MAPSE. All parameters related to LF (not involved in its calculation) were analyzed, and a logistic regression model was performed. Results: a total of 222 patients were evaluated, 59.5% presented with SAS. The prevalence of LF in the general population was 16.7%. The median MAPSE was 1.34 cm (1.2-1.46) in patients with normal flow and 0.99 cm (0.90-1.06) in those with LF (p<0.001). MAPSE demonstrated an area under the curve of 0.89 for the prediction of LF. Multivariate analysis was conducted with the significant variables from the univariate analysis, with age (p=0.011), body surface area (p=0.003), heart rate (p=0.03), and MAPSE (p<0.001) remaining significant. Conclusion: patients with MAS, SAS, and LF had lower MAPSE than those with normal flow. MAPSE is an excellent predictor of LF, and it was the only echocardiographic parameter associated with LF in a multivariate analysis.