Mitral annular plane systolic excursion to left atrial volume ratio - a strainless relation with left ventricular filling pressures

Background: Left atrial reservoir strain (LASr) offers diagnostic and prognostic value in patients with heart failure. However, LASr may be technically challenging and is not routinely evaluated in clinical practice. Since LASr is a consequence of left atrial (LA) stretch during apical descent of the mitral annulus, we hypothesized that a ratio between mitral annular plane systolic excursion (MAPSE) and LA volume (LAV) may offer similar diagnostic value as LASr. Aim: To investigate the relationship between MAPSE/LAV and LASr and evaluate the diagnostic performance of MAPSE/LAV to identify patients with elevated LV filling pressure. Methods: MAPSE/LAV and LA strain measures were obtained in patients referred for echocardiography due to aortic stenosis, and in patients who had undergone clinically indicated right heart catheterization (RHC) with simultaneous echocardiography. Results: In 93 patients with moderate aortic stenosis, MAPSE/LAV was moderately correlated with LASr (r=0.57) but was lower in patients with elevated compared to normal LV filling pressure by echocardiography (0.11 vs. 0.16 mm/mL, p<0.001). In 72 patients who had undergone RHC and simultaneous echocardiography, MAPSE/LAV and LASr correlated weakly with pulmonary artery wedge pressure (PAWP) (r=-0.44 and r=0.37). MAPSE/LAV was lower in patients with elevated (>15 mmHg) vs. normal PAWP (0.14 mm/mL vs. 0.27 mm/mL). Accuracy for detection of elevated PAWP was similar for MAPSE/LAV (area under the curve MAPSE/LAV: 0.75 [0.58-0.92] and LASr: 0.75 [0.57-0.90]). Conclusions: Despite a moderate correlation with LASr, MAPSE/LAV provided similar diagnostic value as LASr regarding LV filling pressures as determined by echocardiography and RHC. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work has been funded in part by grants to TL from Region Kronoberg and the Swedish Heart Lung Association, to PL from The Swedish Heart and Lung foundation (20160787, 20200160) and the Swedish Research Council (2019-01338). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Regional Ethical Review Board in Norrland, Sweden, and the Regional Ethical Review Board in Linkoping which gave ethical approval of this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data underlying this article can be shared upon reasonable request to the corresponding author.