The comparison of mitral annular plane systolic excursion (MAPSE) and mitral annular systolic velocity (Sm) in determining subclinical left ventricular systolic dysfunction in patients with type 2 diabetes mellitus

Background: Type 2 diabetes mellitus (T2DM) is an independent factor in increasing the risk of heart failure in the absence of coronary heart disease and hypertension. Global longitudinal strain (GLS) as the gold standard in determining subclinical left ventricular (LV) systolic dysfunction is not available on all echocardiographic tools and requires good-quality images. Mitral annular plane systolic excursion (MAPSE) and mitral annular peak systolic velocity (Sm) are simpler, faster, and widely available method that can determine left ventricular systolic dysfunction regardless of image quality. Methods: This study involved 72 asymptomatic T2DM patients, divided into two groups, patients with subclinical left ventricular systolic dysfunction (GLS >-18%) and normal systolic function (GLS ≤-18%). GLS was obtained from the mean of 18 left ventricular segments on the apical 4-chamber, 3-chamber and 2-chamber images. MAPSE was obtained on the septal and lateral sides of the mitral annulus using M-mode on apical 4-chamber view, while Sm was obtained using tissue doppler imaging (TDI). Results: The study included 72 asymptomatic T2DM patients, 34 samples (47.2%) were found with subclinical LV systolic dysfunction. According to receiver operating characteristic (ROC) curve analysis, lateral TDI Sm had the highest area under the curve (AUC), it was 0.85, followed by average TDI Sm was 0.83 and average MAPSE was 0.81. The cut-off value of average TDI Sm <7.425 cm/s had the best sensitivity and specificity, 82.4% and 81.6%, while cut-off value of average MAPSE <13.4 mm had sensitivity of 76.5% and specificity of 73.7%. Conclusion: TDI Sm had better accuracy than MAPSE in determining subclinical LV systolic dysfunction in T2DM patients. However, both of them can be used as alternative diagnostic methods of GLS.