Automatic monitoring of single-wall MAPSE by transesophageal echocardiography for tracking global left ventricular function irrespective of regional hypokinesia: a secondary analysis

BACKGROUND: Measuring mitral annular plane systolic excursion (MAPSE) serially in a single wall may be an effective method for monitoring global left ventricular (LV) function, especially when automated with a novel deep learning method using transesophageal echocardiography, called autoMAPSE. However, this assumption is untested in postoperative ICU patients, and the impact of regional wall motion abnormalities (RWMA) is unclear. AIM: To assess the ability of single-wall autoMAPSE in tracking changes in global LV function (i.e., trending ability) using manual global MAPSE averaged from four walls as reference, and to explore how this ability was affected by RWMA. METHODS: This study was a secondary analysis of a prospective observational study. The changes in single-wall autoMAPSE and manual global MAPSE were calculated in 49 patients undergoing cardiac surgery. Trending ability evaluates how well a novel method detects changes in a reference method, which we assessed using four-quadrant plots with concordance rates. To explore the effects of RWMA, we classified RWMA by temporal behavior (persistent or dynamic) and by location relative to single-wall autoMAPSE (same or remote wall), yielding four patterns for analysis of trending ability: (i) remote wall, dynamic RWMA, (ii) remote wall, persistent RWMA, (iii) same wall, dynamic RWMA, and (iv) same wall, persistent RWMA. RESULTS: Overall, single-wall autoMAPSE had adequate trending ability (concordance rate 91%). All LV walls showed adequate trending ability (concordance rate ≥ 90%), except for the septal wall (concordance rate 88%). The effect of RWMA was negligible, as the concordance rates of the four patterns ranged from 89 to 96%. CONCLUSIONS: In this secondary analysis, single-wall autoMAPSE tracked changes in global LV function in 9 out of 10 cases, irrespective of RWMA.