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

Bergenzaun, Lill LU ; Öhlin, Hans LU ; Gudmundsson, Petri; Willenheimer, Ronnie LU and Chew, Michelle LU (2013) In Cardiovascular Ultrasound 11.
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),... (More)
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 (e, E/e) 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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Echocardiography, Intensive care, Mitral annular plane systolic, excursion, Outcome
in
Cardiovascular Ultrasound
volume
11
publisher
BioMed Central
external identifiers
  • wos:000320132000001
  • scopus:84878221066
ISSN
1476-7120
DOI
10.1186/1476-7120-11-16
language
English
LU publication?
yes
id
03def787-8edb-4a0f-b332-2f536ae94307 (old id 3927263)
date added to LUP
2013-08-01 07:35:50
date last changed
2019-04-07 03:47:35
@article{03def787-8edb-4a0f-b332-2f536ae94307,
  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 (e, E/e) and high-sensitive troponin T (hsTNT) (p&lt; 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&lt;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.},
  articleno    = {16},
  author       = {Bergenzaun, Lill and Öhlin, Hans and Gudmundsson, Petri and Willenheimer, Ronnie and Chew, Michelle},
  issn         = {1476-7120},
  keyword      = {Echocardiography,Intensive care,Mitral annular plane systolic,excursion,Outcome},
  language     = {eng},
  publisher    = {BioMed Central},
  series       = {Cardiovascular Ultrasound},
  title        = {Mitral annular plane systolic excursion (MAPSE) in shock: a valuable echocardiographic parameter in intensive care patients},
  url          = {http://dx.doi.org/10.1186/1476-7120-11-16},
  volume       = {11},
  year         = {2013},
}