Diagnostic Accuracy of Lateral Mitral Annular Plane Systolic Excursion for Detecting Left Ventricular Systolic Dysfunction

Abstract

Objectives: To determine the diagnostic accuracy of lateral mitral annular plane systolic excursion (MAPSE) for detecting left ventricular systolic dysfunction (LVSD), using left ventricular ejection fraction (LVEF) assessed by two-dimensional echocardiography as the reference standard. Methodology: This cross-sectional study was conducted at a tertiary care hospital in Karachi and included 137 patients with clinically suspected heart failure. All participants underwent two-dimensional echocardiography. Left ventricular systolic dysfunction was defined as an LVEF <50%, while lateral MAPSE ≤10 mm was considered abnormal. Diagnostic performance parameters including sensitivity, specificity, predictive values, diagnostic accuracy, and 95% confidence intervals were calculated. The association between categorical MAPSE and LVSD was assessed using the Chi-square test, while Spearman’s rank correlation coefficient was used to evaluate the relationship between continuous lateral MAPSE values and LVEF. Receiver operating characteristic (ROC) curve analysis was performed to assess overall discriminatory ability. Results: The mean age of participants was 56.8 ± 13.7 years, and 64.2% were male. Left ventricular systolic dysfunction was present in 109 patients (79.6%). Reduced lateral MAPSE (≤10 mm) was observed in 53 patients, all of whom had LVSD. Lateral MAPSE demonstrated a sensitivity of 48.6% (95% CI: 39.1–58.2%) and a specificity of 100% (95% CI: 87.9–100%), with an overall diagnostic accuracy of 59.1%. A significant positive correlation was observed between lateral MAPSE and LVEF (ρ = 0.695; p <0.001), and a significant association was found between MAPSE category and LVSD (χ² = 22.2; p <0.001). ROC analysis yielded an area under the curve of 0.988 (95% CI: 0.973–1.000; p <0.001). Conclusion: Lateral MAPSE demonstrates excellent specificity but limited sensitivity for detecting left ventricular systolic dysfunction. While it is not suitable as a screening tool, it may serve as a valuable confirmatory parameter in clinical situations where accurate assessment of ejection fraction is limited or technically challenging.