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MAPSE - Measure of Systolic Function



🚨Mitral Annular Plane Systolic Excursion (MAPSE)🚨


🔴Longitudinal displacement of the mitral valve annulus occurs during systole. This distance of this displacement relative to the apex of the heart can be tracked, measured and used as a marker for LV systolic function.


🔴Either the septal or lateral annulus of the mitral valve can be used for MAPSE. An average of the 2 measurements can be used. The M-Mode cursor is placed over the respective mitral valve annulus. 


🔴MAPSE is measured as the distance from the nadir of the M-Mode tracing to the peak 


🪧2D apical 4 chamber images are shown in diastole and systole. Longitudinal movement of the annulus during systole is observed. The M-Mode cursor is placed across the lateral annulus of the mitral valve and a tracing of the displacement during systole is obtained and measured.


MAPSE on Echocardiography: A Simple, Powerful Marker of LV Longitudinal Function


Mitral Annular Plane Systolic Excursion (MAPSE) is one of the most under-used yet remarkably useful echocardiographic parameters. It reflects longitudinal shortening of the left ventricle, a motion primarily generated by subendocardial longitudinal fibers—those most vulnerable to ischemia, hypertension, and myocardial disease.


What is MAPSE?


MAPSE measures how far the mitral annulus moves toward the LV apex during systole.

It is obtained in the apical 4-chamber view using M-mode aligned over the septal and lateral mitral annulus.


Because longitudinal fibers are affected early in many diseases, MAPSE often falls before EF drops, making it a sensitive marker of early LV dysfunction.



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How to Measure MAPSE


1. Get a clear A4C view.



2. Place M-mode cursor exactly through the mitral annulus (septal and then lateral).



3. Measure the total systolic displacement from the annular peak in diastole to its peak in systole.



4. Average septal + lateral = Global MAPSE.





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Normal Values


Region Normal Mild ↓ Moderate ↓ Severe ↓


Septal MAPSE >7 mm 6–7 mm 4–6 mm <4 mm

Lateral MAPSE >10 mm 8–10 mm 6–8 mm <6 mm

Average (Global) ≥10 mm 8–10 mm 6–8 mm <6 mm



Age reduces MAPSE slightly due to declining longitudinal mechanics.



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Clinical Uses of MAPSE


1. Early Detection of LV Dysfunction


MAPSE decreases before EF declines, especially in:


Hypertension


Diabetes


CAD/ischemia


Amyloidosis


Chemotherapy-related cardiotoxicity


HFpEF



2. Quick Bedside Assessment in Critical Care


MAPSE is fast, reproducible, and less load-dependent than EF.

Useful in:


Shock (sepsis, cardiogenic shock)


ICU patients


Limited acoustic windows



3. Assessment of Longitudinal Function in HFpEF


HFpEF patients often have normal EF but reduced longitudinal strain and reduced MAPSE.


4. Prognostic Marker


Low MAPSE correlates with increased mortality in:


Acute coronary syndrome


Heart failure


Post–cardiac surgery patients




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How to Interpret MAPSE


High MAPSE


Hyperdynamic LV (sepsis, anemia, fever)


Early compensated states



Low MAPSE


LV systolic dysfunction (global or regional)


Subendocardial ischemia


Infiltrative cardiomyopathies (amyloidosis → especially low “septal MAPSE”)


RV pressure overload (can reduce septal MAPSE due to septal tethering)


Aging




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MAPSE vs GLS vs EF


Parameter Strengths Limitations


MAPSE Fast, simple, reproducible; good for low-quality images; reflects longitudinal function Angle-dependent; only longitudinal mechanics

GLS Most sensitive marker of LV systolic dysfunction Requires good image quality + speckle tracking

EF Common and widely understood Load-dependent, may appear normal in early disease



MAPSE is excellent for quick assessment and early detection, while GLS offers richer detail and EF provides traditional global function.



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When MAPSE Is Most Useful (Real-World)


When images are poor


When strain software is unavailable


Rapid assessment in ER/ICU


Tracking subtle change in cardiotoxicity patients


Evaluating LV function in HFpEF patients


Infiltrative cardiomyopathy (septal MAPSE often strikingly low)




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Bottom Line


MAPSE is a simple, powerful, and often overlooked marker of LV longitudinal systolic function. It adds significant value to routine echo, especially where GLS or high-quality images are not available. A quick MAPSE measurement can detect dysfunction earlier than EF, improve risk stratification, and guide management in both acute and chronic cardiac conditions.


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