Department of Cardiovascular Medicine, University of Birmingham, Birmingham, UK.
Eur J Heart Fail. 2011 Sep;13(9):953-60. doi: 10.1093/eurjhf/hfr081. Epub 2011 Jul 31.
Current guidelines for the diagnosis of heart failure with normal or preserved ejection fraction (HFpEF) are based on measurements at rest. However, in HFpEF ventricular dysfunction is more apparent on exercise. We hypothesized that Mitral annular plane systolic excursion (MAPSE) which is easy to acquire on exercise could be used to detect occult left ventricular (LV) impairment.
Cardiopulmonary exercise testing and 2D-Doppler echocardiography were performed at rest and on exercise. MAPSE was assessed by using M-mode (apical four-chamber view). Sixty-two patients with HFpEF [LV ejection fraction (LVEF)=60 ± 7%] with reduced VO(2) max (18.6 ± 5.2 mL/min/kg) and 36 control subjects (LVEF=62 ± 7%, VO(2) max 29.4 ± 4.8 mL/min/kg) were studied. MAPSE at rest was significantly lower in patients (10.9 ± 2.1 vs. 12.1 ± 2.2 mm in controls, P= 0.008) which was even more pronounced on exercise (12.0 ± 2.2 mm and 16.2 ± 2.7 mm, respectively, P< 0.001). At rest MAPSE correlated with longitudinal strain (r = 0.432, P= 0.001), peak systolic myocardial velocity (r = 0.545, P< 0.001), and early diastolic myocardial velocity (r = 0.322, P= 0.02) and on exercise with LV apical rotation (r = 0.582, P< 0.001), longitudinal strain (r = 0.589, P< 0.001), and myocardial tissue velocities (P< 0.001). The area under the receiver operating characteristic curve for MAPSE was 0.655 (confidence interval 0.540-0.770) at rest and 0.901 (confidence interval 0.835-0.967) on exercise, to differentiate between patients and controls.
Mitral annular plane systolic excursion at rest and on exercise correlates well with more sophisticated measurements of ventricular function in HFpEF patients. It is potentially a useful and easily acquired measurement, especially on exercise, for the diagnosis of HFpEF.
目前，对于射血分数正常或保留的心衰（HFpEF）的诊断指南基于静息状态下的测量。然而，在 HFpEF 中，心室功能障碍在运动时更为明显。我们假设，在运动中容易获得的二尖瓣环平面收缩期位移（MAPSE）可以用于检测隐匿性左心室（LV）损伤。
在静息和运动时进行心肺运动测试和二维多普勒超声心动图检查。使用 M 型（心尖四腔观）评估 MAPSE。共研究了 62 例 HFpEF 患者[左室射血分数（LVEF）=60±7%]，其最大摄氧量（VO2max）降低（18.6±5.2mL/min/kg），以及 36 名对照者（LVEF=62±7%，VO2max 29.4±4.8mL/min/kg）。患者的静息状态下 MAPSE 明显较低（10.9±2.1 毫米与对照组的 12.1±2.2 毫米，P=0.008），在运动时更为明显（分别为 12.0±2.2 毫米和 16.2±2.7 毫米，P<0.001）。在静息状态下，MAPSE 与纵向应变（r=0.432，P=0.001）、收缩期心肌速度（r=0.545，P<0.001）和舒张早期心肌速度（r=0.322，P=0.02）相关，在运动时与左室心尖旋转（r=0.582，P<0.001）、纵向应变（r=0.589，P<0.001）和心肌组织速度（P<0.001）相关。MAPSE 的受试者工作特征曲线下面积在静息时为 0.655（置信区间 0.540-0.770），在运动时为 0.901（置信区间 0.835-0.967），用于区分患者和对照组。
HFpEF 患者在静息和运动时的二尖瓣环平面收缩期位移与心室功能的更复杂测量密切相关。它是一种潜在的有用且易于获得的测量方法，尤其是在运动时，用于 HFpEF 的诊断。
