Mitral annular plane systolic excursion to left atrial volume ratio as a novel index to assess ventricular filling pressure in dogs with myxomatous mitral valve disease

Abstract

LV diastolic function requires an interpretation of parameters that are conceptually complex, and novel indexes are welcome to improve the analysis. This study aimed to evaluate the MAPSE/LAV ratio as a novel index of diastolic function in dogs with MMVD. A correlation analysis was performed between echocardiographic variables of diastolic function and MAPSE/LAV ratio. A Comparison of MAPSE/LAV ratio between healthy dogs and dogs with MMVD and a comparison of MAPSE/LAV in dogs with different stages of diastolic dysfunction were performed. The MAPSE/LAV ratio diagnostic performance was evaluated using the AUC of the ROC analysis. 410 dogs were included with a median age of the 12 years and a median body weight of 6.1 kg. The MAPSE/LAV ratio showed negative correlation with LA volume in the A2C view (rho = − 0.909, p < 0.001) and LA volume in the A4C view (rho = − 0.910, p < 0.001). Weak and moderate negative correlations were observed with E-wave velocity (rho = − 0.482, p < 0.001), E/A (rho = − 0.331, p < 0.001), EDT (rho = − 0.366, p < 0.001), LA/Ao (rho = − 0.515, p < 0.001), E/E’ (rho = − 0.462, p < 0.001), and E/IVRT (rho = − 0.383, p < 0.001). There was positive correlation with Ea’ (rho = 0.191, p = 0.001), Ea′ lateral (rho = 0.166, p = 0.006), Ea′ septal (rho = 0.183, p = 0.002), MAPSE lateral (rho = 0.312, p < 0.001), and MAPSE septal (rho = 0.293, p < 0.001). The MAPSE/LAV ratio across different diastolic function stages was statistically different (p < 0.05). Dogs with more severe MMVD had significantly lower MAPSE/LAV ratio (p < 0.05). The diagnostic performance of the MAPSE/LAV ratio alone and when replacing TR, was clinically relevant, with AUC of the ROC analysis of 0.723 (95% CI, 0.663-0.783) and 0.809 (95% CI, 0.753-0.865), respectively. The MAPSE/LAV ratio has excellent reproducibility and modest diagnostic performance, highlighting its value as a clinically useful tool in the assessment of diastolic function.