Abstract
BackgroundAssessing 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.MethodsIn 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.ResultsMAPSE 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).ConclusionsMAPSE 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.
Highlights
Assessing left ventricular (LV) dysfunction by echocardiography in ICU patients is common
LV systolic dysfunction has been observed in critically ill patients with shock [2,3] there is conflicting evidence that LV systolic impairment is associated with mortality [2,4,5]
We found that mitral annular plane systolic excursion (MAPSE) on day 1 was significantly lower in non-survivors compared to survivors and could together with Sequential Organ Failure Assessment (SOFA) score be identified as independent predictors of 28-day mortality
Summary
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. LV systolic dysfunction has been observed in critically ill patients with shock [2,3] there is conflicting evidence that LV systolic impairment is associated with mortality [2,4,5]. The aim of this study was to investigate if MAPSE is of prognostic significance in critically ill patients with shock. We wanted to examine if MAPSE correlates with other markers of LV function and myocardial injury
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