The Diagnostic and Prognostic Value of Mitral Annular Plane Systolic Excursion (MAPSE) as an Echocardiographic Indicator of Myocardial Dysfunction in Sepsis and Septic Shock

Objectives: Validation of mitral annular plane systolic excursion (MAPSE) as a rapid easy marker of left ventricle (LV) systolic function in general, and as an independent predictor of systolic function and mortality among patients with septic shock.

Background: Sepsis-induced myocardial dysfunction is one of the major predictors of morbidity and mortality in sepsis. Cardiac ultrasonography has become an indispensible tool in ICU for management of hemodynamically unstable critically ill patients, and MAPSE has been suggested as a surrogate measurement for LV function.

Methods: Prospective analysis of 50 septic shock patients by transthoracic echocardiography was carried out. MAPSE, LV ejection fraction (LVEF) measured by modified Simpson’s method, and mitral annular systolic velocity by tissue Doppler imaging TDI were measured every other day for 1 week, and they were correlated with cardiac injury biomarkers and mortality predictors.

Results: MAPSE values correlated significantly with sequential organ failure assessment score (SOFA score) among survived and non-survived patients (average; r – 0.95 with p-value <0.001 and average; r – 0.85 & 0.84 with p-value <0.001 respectively), with high percentage of non-survivor group had MAPSE ˂ 9 mm, on the other hand high percentage of survivor group had MAPSE ≥ 9 mm, and regarding receiver operating characteristic (ROC) curves for mortality prediction; MAPSE was (95.5% sensitivity, 67.9% specificity, and 92% accuracy for cut-off value of ≤ 8.8 mm). Also, it was found that there was statistically significant positive correlation with p-value <0.05 between MAPSE with LVEF and systolic mitral annular velocity TDI S' values, with high percentage of LVEF value ≤ 50% had MAPSE ˂ 9 mm and TDI S' ≤ 8 cm/sec, on the other hand high percentage of LVEF value > 50% had MAPSE ≥ 10 mm and TDI S' > 8 cm/sec, and regarding ROC curve for prediction of LVEF of value ≤ 50%; MAPSE measurement was (98.1% sensitivity, 90.9% specificity, and 96.4% accuracy for cut-off value of ≤ 9 mm).

Conclusion: MAPSE value is thought to be an independent tool for LV systolic function assessment generally, as well as myocardial injury in patients with sepsis induced myocardial dysfunction, and also a predictor of mortality in patients with severe sepsis and septic shock.