The article examines the objective, findings, and clinical context described in Authors’ response to comments on MAPSE in critical illness: translating prognostic associations into clinical practice.
Approach:
Clinical use: The authors assessed MAPSE feasibility and prognostic value alongside other measures of longitudinal left ventricular function in a broad ICU population; they did not propose MAPSE as a stand-alone trigger for inotropic therapy.
Population and subgroup analyses: The cohort was deliberately heterogeneous. Subgroup analyses were exploratory, with broad confidence intervals and inconsistent statistical significance after adjustment.
Mitral annular calcification: Patients were not excluded solely for mitral annular calcification (MAC), to retain a clinically representative ICU population.
Key Findings:
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.
MAPSE measurement was substantially more feasible than Simpson biplane LVEF measurement in this population.
Interpretation:
The authors state that MAPSE may provide prognostic information not fully represented by conventional LVEF assessment and may contribute to integrated echocardiographic evaluation and risk stratification. It should be interpreted alongside other echocardiographic findings and the patient’s overall clinical status.
Limitations:
Exploratory subgroup analyses had broad confidence intervals and may have been limited by small subgroup sizes and statistical power.
The study did not establish whether serial MAPSE assessments add clinically useful information beyond a single baseline measurement.
The authors identify the need for studies with prespecified aetiological strata, interaction analyses, and serial echocardiographic evaluations.
Conclusion:
The results should not be construed as endorsing MAPSE-guided treatment. The authors describe MAPSE as a potential component of integrated assessment and risk stratification in critically ill patients.
