Clinical Scorecard: Authors’ response to comments on MAPSE in critical illness: translating prognostic associations into clinical practice

At a Glance

Key Highlights

• Reduced MAPSE alone is not an indication for inotropic therapy or another specific intervention.
• MAPSE should be interpreted alongside other echocardiographic findings and the patient’s overall clinical assessment.
• Lower MAPSE remained independently associated with 90-day mortality after adjustment for age, SAPS 3, and cardiac index.
• LVEF was no longer associated with mortality after adjustment, and MAPSE measurement was more feasible than Simpson biplane LVEF in this population.
• Subgroup analyses were exploratory, with broad confidence intervals and inconsistent statistical significance after adjustment.

Guideline-Based Recommendations

Diagnosis

• Consider MAPSE as one measure of longitudinal left ventricular function within an integrated echocardiographic assessment.
• Account for mitral annular calcification when interpreting MAPSE.

Management

• Do not use reduced MAPSE as a stand-alone trigger for inotropic support or another intervention.
• Base decisions about inotropic support on the individual patient’s overall haemodynamic and clinical status.

Monitoring & Follow-up

• The clinical value of serial MAPSE assessments beyond a single baseline measurement remains unresolved.

Risks

• Underlying mechanisms associated with reduced MAPSE may differ among ICU patients.
• Subgroup findings are limited by smaller sample sizes, broad confidence intervals, and reduced statistical power.

Patient & Prescribing Data

Critically ill patients in a heterogeneous ICU cohort; patients were not excluded solely because of mitral annular calcification.

The article does not endorse MAPSE-guided treatment. Inotropic support decisions should reflect the patient’s overall haemodynamic and clinical status.

Clinical Best Practices

• Use MAPSE as a potential contributor to risk stratification, not as a stand-alone treatment trigger.
• Interpret MAPSE together with other echocardiographic findings and the global clinical assessment.
• Recognize that mitral annular calcification can affect MAPSE interpretation.
• Further studies could use prespecified aetiological strata, interaction analyses, and serial echocardiographic evaluations to assess variation in MAPSE’s prognostic value and feasibility.

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