Diagnostic and Prognostic Utility of Mitral Annular Plane Systolic Excursion: A Systematic Review and Meta-Analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: MAPSE vs LVEF: pooled r = 0.64; MAPSE vs GLS: pooled r = 0.53. Prognostic superiority over LVEF and GLS reported in several studies (narrative synthesis only)

• Primary Outcome: Correlation of MAPSE with established markers of left ventricular systolic function (LVEF and GLS), and prognostic performance for adverse cardiovascular events

• Nnt Or Sensitivity: No NNT, sensitivity, specificity, or AUC values reported in the abstract. Prognostic effect sizes (hazard ratios, odds ratios) not pooled quantitatively. Diagnostic threshold values for MAPSE not specified.

• Confidence Interval: MAPSE vs LVEF: 95% CI 0.54–0.74; MAPSE vs GLS: 95% CI 0.45–0.63

Clinical Application

MAPSE measurement is described as fast, simple, and easily automated across multiple imaging modalities (TTE, CMR, TOE, CT). This supports integration into existing workflows without significant resource implications. Automated measurement reduces operator dependency and inter-observer variability. The technique is particularly valuable in patients with suboptimal echocardiographic windows where LVEF assessment is unreliable. MAPSE measurement is not currently mandated by RACGP, CSANZ, or major Australian cardiac imaging guidelines. Echocardiography is widely available in Australian public and private settings and is Medicare-rebatable (MBS item numbers for echocardiography include 55113, 55116, 55119). CMR is available at major centres including Royal North Shore Hospital (an author-affiliated institution), though access remains limited in regional and remote areas. TGA approval is not relevant as MAPSE is a measurement technique rather than a therapeutic agent or device. Integration of MAPSE into routine echocardiography reporting would require endorsement from CSANZ imaging guidelines and potentially ASUM. The finding that MAPSE detects systolic impairment despite preserved LVEF is particularly relevant to the growing Australian HFpEF population. PBS implications are indirect — earlier detection of systolic dysfunction may influence eligibility for PBS-listed heart failure therapies (e.g., sacubitril/valsartan, SGLT2 inhibitors under PBS restrictions). Adult patients undergoing cardiac imaging for assessment of left ventricular systolic function, particularly those with poor echocardiographic windows, heart failure with preserved ejection fraction (HFpEF), cardiomyopathies, valvular heart disease, and other conditions where subclinical systolic impairment may be present despite normal LVEF

Abstract

BACKGROUND: Movement of the mitral annulus toward the left ventricular (LV) apex during systole, termed atrioventricular plane displacement or mitral annular plane systolic excursion (MAPSE), was first observed by Leonardo da Vinci in the 15th century. MAPSE, a measure of longitudinal movement, shows good agreement between transthoracic echocardiography and cardiovascular magnetic resonance imaging and can also be measured by transesophageal echocardiography and cardiac computed tomography. Measurement is fast, simple, and easily automated. However, no major imaging guidelines advise routine measurement. METHODS: We present a systematic review of studies appraising the diagnostic and prognostic performance of MAPSE from PubMed, Medline, Google Scholar, and Embase until September 2025 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Studies assessing MAPSE in adult populations were included, and non-English publications, abstracts, and studies of congenital heart disease were excluded. Newcastle-Ottawa Scale assessed study quality. Correlation coefficients between MAPSE and markers of systolic function were pooled using Hunter-Schmidt meta-analysis. Heterogeneous diagnostic and prognostic outcomes were synthesized narratively. RESULTS: The review included 92 studies. MAPSE correlated with LV ejection fraction (r=0.64 [95% CI, 0.54-0.74]) and global longitudinal strain (r=0.53 [95% CI, 0.45-0.63]), showing a modest association with systolic function, particularly useful in patients with poor echocardiographic windows. MAPSE was frequently reduced despite preserved LV ejection fraction across multiple pathologies, enabling earlier detection of systolic impairment. MAPSE also demonstrated strong prognostic value, outperforming LVEF and global longitudinal strain in predicting adverse events in several studies. CONCLUSIONS: Overall, MAPSE has a clinically important role meriting integration into routine cardiac imaging and care.

References

1. 1.Falconer, D., Fröjdh, F., Wyeth, N., Brieger, D., Captur, G., Kozor, R., & Ugander, M. (2026). Diagnostic and prognostic utility of mitral annular plane systolic excursion: A systematic review and meta-analysis. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.047439