The value of Mitral annular plane systolic excursion for detection and
significance of coronary artery disease in Dobutamine stress
echocardiography.
Abstract
Dobutamine stress echocardiography (DSE) is a test recommended for
diagnosing coronary artery disease (CAD), which can also assess its
severity. MAPSE (M-mode-derived long axis, mitral annular plane systolic
excursion) can be used to measure the longitudinal shortening of the
Left Ventricle (LV) which plays a major role in the pumping function of
the cardiac muscle. For detecting early abnormalities, this parameter
appears to be much more sensitive than global EF. Objective: In
order to determine whether Delta change MAPSE in Dobutamine stress
Echocardiography predicts ischemic heart disease and whether it
correlates with coronary artery disease severity in patients with
ischemic heart disease. Patients and Methods: This study
evaluated 60 patients between April 2020 and July 2021, 30 of whom were
ischemic (ischemic group) and 30 of whom were not (normal group). The
MAPSE (septal, lateral, anterior, inferior anulus) is measured at each
stress echo stage and the Delta MAPSE (Peak MAPSE – rest MAPSE) is
calculated. Additionally, the EF is measured using modified Simpson’s
method for each stage and the Delta EF (Peak EF – rest EF) is
determined. These measurements are then compared between two groups. The
severity of coronary artery disease is assessed using the Gensini score
(GS). Results: Our study comprised a total of 60 patients, with
an average age of 59.5 ± 7.3 years. The male gender was predominant,
accounting for 74% of the participants. A notable disparity was
observed between the two groups in terms of their diabetic history,
which was statistically significant. Specifically, 53% of the patients
had diabetes, whereas only 27% of the control group had the condition
(p=0.035). There was a statistically significant difference observed
between the two groups in terms of Delta MAPSE (p<0.0001). The
Delta MAPSE in patients was recorded as -0.54 ± 0.3, whereas in the
control groups it was 0.88 ± 0.7. Additionally, a statistically
significant difference was found between the two groups based on Delta
EF (p=0.012). The Delta EF in patients was measured as 1.5±5.6, while in
the control groups, it was 4.8±3.9. There was a significant negative
correlation observed between delta MAPSE and Gensini score in the
patients’ group (P= 0.0085; r = - 0.47). Conversely, a negative
correlation was also observed between delta EF and Gensini score in the
patients’ group, although it was not statistically significant (P= .029;
r = - 0.2). Conclusion: The reduced MAPSE in dobutamine stress
echocardiography (DSE) is an efficient and straightforward quantitative
echocardiographic technique that can accurately anticipate both the
existence and the extent of coronary artery disease (CAD).