Mitral annular plane systolic excursion
MAPSE · M-mode through the septal and lateral mitral annulus in the apical 4-chamber view; average the two
Normal range & thresholds
Normal ≥10–12 mm (lateral typically 12–15 mm, septal 10–13 mm). MAPSE <8 mm predicts LVEF <50%; <7 mm carries adverse prognosis in heart failure.[56] Note: unlike TAPSE for the right ventricle, MAPSE is not a required measurement in the ASE/EACVI chamber quantification guideline — the reference values come from validation studies, and that difference in evidential status should be stated when it is reported.[1]
Pathophysiology
MAPSE is the displacement counterpart of S′: it measures how far the base descends toward a relatively fixed apex, and that descent is produced almost entirely by longitudinal subendocardial fibres. Because base-to-apex shortening also expands the left atrium and draws blood in, a low MAPSE simultaneously signals impaired systolic and impaired suction-mediated filling.
Raised by
- Hyperdynamic circulation, exercise, inotropes
- Significant mitral regurgitation (unloading of the annulus — falsely reassuring)
- Young, athletic subjects
Lowered by
- Global systolic dysfunction of any cause
- Regional: previous infarction in the sampled wall (measure both annuli and interpret regionally)
- Infiltrative and hypertrophic disease — falls early, before LVEF
- Mitral annular calcification, annuloplasty ring, prosthetic mitral valve
- Post-cardiac surgery (septal MAPSE drops and stays down)
- Constrictive pericarditis (lateral more than septal); severe RV pressure overload
- Ageing
Technique & pitfalls
- Align the M-mode cursor along the direction of annular motion, not simply through the annulus — an angled cursor systematically underestimates.
- Measure from the most apical (end-systolic) to the most basal (end-diastolic) position of the annulus.
- Average septal and lateral; state whether the value is an average or a single site.
- Particularly valuable when endocardial definition is too poor for Simpson volumes and no contrast is available, and in atrial fibrillation where it is comparatively robust across cycles.
- Anatomical M-mode (post-processing) rescues an unalignable cursor but is not interchangeable with conventional M-mode.
Pseudo-change & artefact
- Cursor misalignment — the dominant error, always in the direction of underestimation.
- Whole-heart translation and respiratory motion inflate the excursion.
- Foreshortened apical view alters the vector of annular motion.
- Load dependence: falls with hypovolaemia, rises with volume loading.
- Regional wall motion abnormality in the sampled wall makes the value non-representative of global function.
- Post-pericardiotomy septal motion — abnormal but not new disease.
Treatment thresholds
- No guideline treatment threshold. MAPSE is a supportive and screening measure, useful when better measures are unavailable.
- Its practical roles: rapid bedside surrogate for LVEF in poor windows or point-of-care settings; a robust systolic index in atrial fibrillation; and an early marker of longitudinal dysfunction in infiltrative disease and cardio-oncology follow-up when strain is not available.
Next step
- Next: if MAPSE is low, quantify properly — contrast-enhanced biplane LVEF and GLS.
- Then: establish the cause exactly as for a reduced LVEF (ischaemia, tissue characterisation, rhythm).
- Then: if MAPSE is low but LVEF normal, treat it as the same signal as a reduced GLS — look for infiltration, early cardiotoxicity, or hypertensive/valvular subendocardial disease.
Drugs
- Same directional effects as for S′ and LVEF: improved by GDMT, revascularisation and CRT; reduced by cardiotoxic agents and by acute beta-blockade.
- No drug targets MAPSE itself.
Reversibility
Recovers in proportion to the underlying myocardium, on the same timescale as ejection fraction. The two exceptions worth knowing: the septal drop after any cardiac operation is essentially permanent and benign, and annular tethering by a mitral annuloplasty ring or prosthesis is a permanent mechanical constraint rather than a contractile deficit.