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Mitral annular plane systolic excursion for assessing left ventricular systolic dysfunction in patients with septic shock

BACKGROUND: Using easy-to-determine bedside measurements, we developed an echocardiographic algorithm for predicting left ventricular ejection fraction (LVEF) and longitudinal strain (LVLS) in patients with septic shock. METHODS: We measured septal and lateral mitral annular plane systolic excursion...

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Detalles Bibliográficos
Autores principales: Brault, Clément, Zerbib, Yoann, Mercado, Pablo, Diouf, Momar, Michaud, Audrey, Tribouilloy, Christophe, Maizel, Julien, Slama, Michel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10457489/
https://www.ncbi.nlm.nih.gov/pubmed/37638090
http://dx.doi.org/10.1016/j.bjao.2023.100220
Descripción
Sumario:BACKGROUND: Using easy-to-determine bedside measurements, we developed an echocardiographic algorithm for predicting left ventricular ejection fraction (LVEF) and longitudinal strain (LVLS) in patients with septic shock. METHODS: We measured septal and lateral mitral annular plane systolic excursion (MAPSE), septal and lateral mitral S-wave velocity, and the left ventricular longitudinal wall fractional shortening in patients with septic shock. We used a conditional inference tree method to build a stratification algorithm. The left ventricular systolic dysfunction was defined as an LVEF <50%, an LVLS greater than −17%, or both. RESULTS: We included 71 patients (males: 61%; mean [standard deviation] age: 61 [15] yr). Septal MAPSE (cut-off: 1.2 cm) was the best predictor of left ventricular systolic dysfunction. The level of agreement between the septal MAPSE and the left ventricular systolic dysfunction was 0.525 [0.299–0.751]. A septal MAPSE ≥1.2 cm predicted normal LVEF in 17/18 patients, or 94%. In contrast, a septal MAPSE <1.2 cm predicted left ventricular systolic dysfunction with impaired LVLS in 46/53 patients (87%), although 32/53 (60%) patients had a preserved LVEF. CONCLUSIONS: Septal MAPSE is easily measured at the bedside and might help clinicians to detect left ventricular systolic dysfunction early—especially when myocardial strain measurements are not feasible.