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. 2013 May 30:11:16.
doi: 10.1186/1476-7120-11-16.

Mitral annular plane systolic excursion (MAPSE) in shock: a valuable echocardiographic parameter in intensive care patients

Lill Bergenzaun  1 , Hans Ohlin, Petri Gudmundsson, Ronnie Willenheimer, Michelle S Chew
Affiliations

Mitral annular plane systolic excursion (MAPSE) in shock: a valuable echocardiographic parameter in intensive care patients

Lill Bergenzaun et al. Cardiovasc Ultrasound. .

Abstract

Background: Assessing left ventricular (LV) dysfunction by echocardiography in ICU patients is common. The aim of this study was to investigate mitral annular plane systolic excursion (MAPSE) in critically ill patients with shock and its relation to LV systolic and diastolic function, myocardial injury and to outcome.

Methods: In a prospective, observational, cohort study we enrolled 50 patients with SIRS and shock despite fluid resuscitation. Transthoracic echocardiography (TTE) measuring LV function was performed within 12 hours after admission and daily for a 7-day observation period. TTE and laboratory measurements were related to 28-day mortality.

Results: MAPSE on day 1 correlated significantly with LV ejection fraction (LVEF), tissue Doppler indices of LV diastolic function (é, E/é) and high-sensitive troponin T (hsTNT) (p< 0.001, p= 0.039, p= 0.009, p= 0.003 respectively) whereas LVEF did not correlate significantly with any marker of LV diastolic function or myocardial injury. Compared to survivors, non-survivors had a significantly lower MAPSE (8 [IQR 7.5-11] versus 11 [IQR 8.9-13] mm; p= 0.028). Other univariate predictors were age (p=0.033), hsTNT (p=0.014) and Sequential Organ Failure Assessment (SOFA) scores (p=0.007). By multivariate analysis MAPSE (OR 0.6 (95% CI 0.5- 0.9), p= 0.015) and SOFA score (OR 1.6 (95% CI 1.1- 2.3), p= 0.018) were identified as independent predictors of mortality. Daily measurements showed that MAPSE, as sole echocardiographic marker, was significantly lower in most days in non-survivors (p<0.05 at day 1-2, 4-6).

Conclusions: MAPSE seemed to reflect LV systolic and diastolic function as well as myocardial injury in critically ill patients with shock. The combination of MAPSE and SOFA added to the predictive value for 28-day mortality.

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Figures

Figure 1
Figure 1
Receiver operating characteristic (ROC) for MAPSE and for a combined predictor consisting of MAPSE and SOFA score. With regards to 28-day mortality the area under the curve (AUC) for MAPSE was 0.709 (95% CI 0.548- 0.870, p= 0.028) and for the combined predictor 0.831 (95% CI 0.711- 0.952, p<0.001).
Figure 2
Figure 2
Boxplots of daily measurements show that MAPSE is significantly lower in non-survivors (grey) of 28-day mortality compared to survivors (white) in most days (day 1 p=0.028, day 2 p=0.003, day 3 p=0.060, day 4 p= 0.036, day 5 p=0.026, day 6 p=0.017, day 7 p=0.075). ° Value and case number within 1.5 boxplot length (SPSS 18.0).
Figure 3
Figure 3
Boxplots of daily measurements show that there is no significant difference (p>0.1) at any day in LVEF between survivors (white) and non-survivors (grey) of 28-day mortality. ° Value and case number within 1.5 boxplot length (SPSS 18.0).
See this image and copyright information in PMC

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