Shah Asim, Nanjayya Vinodh, Ihle Josh
The Alfred ICU Melbourne Victoria 3004 Australia.
Australas J Ultrasound Med. 2019 Feb 23;22(2):138-142. doi: 10.1002/ajum.12131. eCollection 2019 May.
The accurate measurement of Left Ventricular Ejection Fraction (LVEF) requires high-quality images and echocardiography expertise. Critically ill patients can present challenges in obtaining good acoustic windows for ultrasound, particularly for ICU trainees early in their ultrasound learning. Mitral Annular Plane Systolic Excursion (MAPSE), a simple measurement, may be useful in this context to estimate LV systolic function.
All adult patients admitted to the Alfred ICU between August 2012 and February 2013 who were on mechanical ventilation and needed an echocardiography examination were eligible to be included in the study. An ICU trainee in their first year of echocardiography training performed MAPSE measurements. An advanced echocardiographer classified LV systolic function into normal, mild, moderate or severe categories based on the visual estimation of LVEF. The relationship between the MAPSE measurements and the range of LV systolic function was assessed.
Amongst 39 patients, the mean (SD) age was 55 (18.6) years, 20 (50%) were males, 36 (90%) were in sinus rhythm, 19 (48%) were on vasopressors, 12 (30%) were on inotropes and 23 (58%) were on mandatory mode mechanical ventilation. The mean (SD) MAPSE was 12.2 (5.28) mm. 28 (70%) of the patients had normal or mildly reduced LVEF. The ROC analysis showed that a MAPSE cut-off point of ≥12.5 mm diagnosed normal or mildly reduced LVEF with 82.14% sensitivity and 91.67% specificity. The area under ROC curve was 0.91 (95% CI 0.82-1.00).
MAPSE is useful as a surrogate for LVEF in mechanically ventilated patients. In early critical care echocardiography training, a novice learner can perform MAPSE easily, accurately, and find it helpful for assessment of LVEF.
准确测量左心室射血分数（LVEF）需要高质量的图像和超声心动图专业知识。重症患者在获取良好的超声声学窗方面可能存在挑战，尤其是对于刚开始学习超声的重症监护病房（ICU）实习医生。二尖瓣环平面收缩期位移（MAPSE）是一种简单的测量方法，在此背景下可能有助于评估左心室收缩功能。
2012年8月至2013年2月期间入住阿尔弗雷德ICU且接受机械通气并需要进行超声心动图检查的所有成年患者均符合纳入本研究的条件。一名处于超声心动图培训第一年的ICU实习医生进行MAPSE测量。一名高级超声心动图医生根据对LVEF的视觉估计将左心室收缩功能分为正常、轻度、中度或重度类别。评估MAPSE测量值与左心室收缩功能范围之间的关系。
39例患者中，平均（标准差）年龄为55（18.6）岁，20例（50%）为男性，36例（90%）为窦性心律，19例（48%）使用血管活性药物，12例（30%）使用正性肌力药物，23例（58%）采用强制模式机械通气。平均（标准差）MAPSE为12.2（5.28）mm。28例（70%）患者的LVEF正常或轻度降低。ROC分析显示，MAPSE截断点≥12.5 mm诊断LVEF正常或轻度降低的敏感度为82.14%，特异度为91.67%。ROC曲线下面积为0.91（95%可信区间0.82 - 1.00）。
MAPSE可作为机械通气患者LVEF的替代指标。在早期重症监护超声心动图培训中，新手学习者能够轻松、准确地进行MAPSE测量，并发现其有助于评估LVEF。
