Non Invasive Cardiology, Lenox Hill Hospital, North Shore LIJ Health System, New York, New York, USA.
J Am Soc Echocardiogr. 2012 Sep;25(9):969-74. doi: 10.1016/j.echo.2012.06.011. Epub 2012 Jul 12.
Assessing left ventricular function is a common indication for echocardiography. It generally requires expert echocardiographer estimation and is somewhat subjective and prone to reader discordance. Mitral annular plane systolic excursion (MAPSE) has been suggested as a surrogate measurement for left ventricular function. The aim of this study was to examine the accuracy of MAPSE for predicting left ventricular ejection fraction (EF) on the basis of a large cohort of consecutive echocardiograms.
The study design was a retrospective analysis of 600 two-dimensional echocardiographic studies performed in a single laboratory. MAPSE measurement was performed by an untrained observer and compared with the EF as determined by an expert echocardiographer. The first 300 studies served as a calibration cohort to establish an algorithm for predicting EF on the basis of MAPSE measurement. The following 300 studies served as a verification cohort to test the accuracy of the established algorithm.
Using the first 300 studies, an algorithm was developed to predict EF. Cutoff values for normal EF (≥11 mm for women and ≥13 mm for men) and severely reduced EF (<6 mm for men and women) were identified. For the intermediate-range MAPSE values, a gender-specific regression equation was calculated to generate a predicted EF. Using this algorithm, predicted EFs were determined for the 300 patients in the verification cohort. By comparing the predicted EF and the expert-reported EF, positive and negative predictive values, sensitivity (73%-92%), specificity (81%-100%), and accuracy (82%-86%) of MAPSE for predicting EF were calculated.
MAPSE measurement by an untrained observer was found to be a highly accurate predictor of EF.
评估左心室功能是超声心动图的常见适应证。它通常需要由专家超声心动图医师进行评估，具有一定的主观性，并且容易出现观察者之间的差异。二尖瓣环平面收缩期位移（MAPSE）已被提议作为左心室功能的替代测量方法。本研究旨在基于大量连续超声心动图检查，研究 MAPSE 预测左心室射血分数（EF）的准确性。
研究设计是对单个实验室进行的 600 项二维超声心动图研究的回顾性分析。由未经训练的观察者进行 MAPSE 测量，并与由专家超声心动图医师确定的 EF 进行比较。前 300 项研究作为校准队列，以建立基于 MAPSE 测量预测 EF 的算法。随后的 300 项研究作为验证队列，以测试既定算法的准确性。
使用前 300 项研究，开发了一种预测 EF 的算法。确定了正常 EF（女性≥11mm，男性≥13mm）和严重降低 EF（男性和女性<6mm）的截断值。对于中间范围的 MAPSE 值，计算了性别特异性回归方程以生成预测的 EF。使用该算法，为验证队列中的 300 名患者确定了预测的 EF。通过比较预测的 EF 和专家报告的 EF，计算了 MAPSE 预测 EF 的阳性和阴性预测值、敏感性（73%-92%）、特异性（81%-100%）和准确性（82%-86%）。
由未经训练的观察者进行的 MAPSE 测量被发现是 EF 的高度准确预测指标。
