Relationship between Mitral Annular Plane Systolic Excursion and Left Ventricular Ejection Fraction by Modified Simpson\'s Method Using Point of Care Cardiac Ultrasound: An Observational Analytical Study

INTRODUCTION: The standard accepted method for assessment of left ventricular ejection fraction (LVEF) is modified Simpson's method but it takes time and may not be feasible in emergent conditions. Mitral annular plane systolic excursion (MAPSE) occurs due to contraction of longitudinal fibers and represents myocardial contractility. It is measured on M-mode of ultrasound. It is technically easier and quicker to obtain and may be assessed even with poor cardiac window. PRIMARY OBJECTIVE: To find the relationship between MAPSE and LVEF by modified Simpson's method using point of care cardiac ultrasound. METHODOLOGY: A prospective observational study was conducted in two parts. In the first part, 75 patients were recruited for determining the relationship between MAPSE and LVEF by modified Simpson's method. It was validated in the second part in 75 patients by comparing its result with LVEF obtained from 4.8 × MAPSE + 5.8 (males) or 4.2 × MAPSE + 20 (females) and modified Simpson's method. RESULTS: Equation obtained was EF= 3.27 × (MAPSE) + 17.92 (ρ=0.761, R(2)=0.520). The average time for MAPSE was 51.47 ± 11.18 s and for modified Simpson's method was 192.27 ± 31.93 s. We calculated PPV (93.33%), NPV (73.33%), sensitivity (93.33%), specificity (73.33%) and accuracy (89.33%) for the equation. A MAPSE of 10.325 mm, predicts a normal EF with a 90.7% sensitivity and 90.6% specificity. CONCLUSION: MAPSE correlates well with the EF measured by modified Simpson's method. It is faster and provides a good estimation as to whether the contractility is preserved or decreased.