Mitral annular Plane Systolic Excursion (Mapse) in Shock : a Valuable Echocardiographic Parameter in Intensive Care Patients

INTRODUCTION. Assessing left ventricular (LV) dysfunction by echocardiography in ICU patients is common. In patients with cardiovascular disease mitral annular plane sys- tolic excursion (MAPSE) is known to be more sensitive in detecting abnormalities in LV function at an early stage, easily obtainable and related to prognosis. OBJECTIVES. The aim of this study was to investigate 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) mea- suring LV systolic and diastolic function was performed within 12 h after admission and daily for a 7-day observation period. TTE and laboratory measurements (high-sensitive troponin T (hsTNT), B-natriuretic peptide [BNP]) were related to 28-day mortality. Spearman rank correlation was used. RESULTS. MAPSE on day 1 correlated significantly with LV ejection fraction (LVEF), tissue Doppler indices of LV diastolic function (e ́ , E/e ́ ) and hsTNT whereas LVEF did not correlate significantly with any marker of LV diastolic function or myocardial injury; tissue Doppler of LV systolic function (TDIs) correlated significantly with LVEF and e ́ (Table 1). 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 mor- tality. 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 mortalit