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Hany Fayed, Rashed Hamdan, Mohammed Alrashidi, Zohair Bitar, Osama Maadarini, Mohammed Habibi, Moutaz Aldaher
(Department of Internal Medicine, Ahmadi Hospital, Cardiology Unit, Kuwait City, Kuwait)
Med Sci Hypotheses 2018; 5:1-5
Assessment of severity of aortic valve stenosis depends not only on measuring the trans-valvular peak and mean gradient, but also the indexed valve area. Recently, low-flow low-gradient and low-flow high-gradient severe aortic valve stenosis have been shown to depend on measuring the indexed left ventricle stroke volume. Here, we evaluated the usefulness of MAPSE in assessing indexed left ventricle stroke volume.
We assessed whether MAPSE is a reliable surrogate for left ventricle stroke volume, which, if true, can be used to diagnose the low-flow sub-group of patients with severe aortic valve stenosis and in critical care patients with shock.
MATERIAL AND METHODS: A convenience sample of 50 patients was included in the study. By using transducer 5 MHZ of Philips IE-33 Transthoracic echocardiogram, MAPSE (averaged from 3 consecutive cycles) was measured after taking the average of the septal and lateral mitral annulus indexed to body surface area, as well as measuring the LVOT diameter and the VTI at LVOT to calculate the stroke volume (>35 ml/beat indexed). We excluded patients with LBBB, EF <50%, pericardial constriction, old MI, AF, mitral valve repair and prosthetic valve at mitral position, and moderate-to-severe mitral and aortic valve regurgitation. Statistically, we were looking for a high correlation between MAPSEi and indexed left ventricle stroke volume.
RESULTS: There was a significant high correlation between MAPSE and indexed LV stroke volume. MAPSEi <7 is a highly accurate predictor of low (<35 ml/beat) SVi.
CONCLUSIONS: Mitral annular plane systolic excursion is a more useful, easy, and quick compared with stroke volume using LVOT area and VTI measurement, which is inaccurate and time-consuming.