Study Clarifies Bedside MAPSE Utility and Prognostic Value in Critical Care

In a scientific correspondence published in Critical Care, researchers Oscar Cavefors and Jonatan Oras clarified the clinical utility and interpretive boundaries of mitral annular plane systolic excursion among critically ill patients. Addressing commentary regarding their study on longitudinal left ventricular function, the authors underscored that reduced measurements of this bedside echocardiographic parameter should not be construed as an autonomous indication for initiating inotropic therapy. The primary investigation was designed to evaluate the practical feasibility and prognostic relevance of mitral annular plane systolic excursion across a broad, heterogeneous intensive care unit cohort, rather than to establish an isolated physiological trigger for therapeutic interventions. Decisions concerning inotropic support, the investigators emphasized, must continually depend upon the comprehensive haemodynamic state and overall clinical evaluation of each individual patient.

The authors explained that the primary clinical value of mitral annular plane systolic excursion lies in its capacity to serve as an accessible bedside marker for patient risk stratification when integrated with broader diagnostic data. While decreased displacement of the mitral annulus reflects impaired longitudinal left ventricular mechanics, the investigators noted that such measurements were never intended to function as stand-alone criteria for clinical management. Instead, any observed reduction in annular excursion must be interpreted alongside concurrent echocardiographic findings and the overarching clinical assessment of the critically ill individual. Cavefors and Oras maintained that establishing whether repeated measurements over time provide clinically useful information beyond a single baseline assessment remains an important question that warrants targeted examination in future studies.

Addressing considerations regarding variability within the study population, the researchers agreed that lower mitral annular displacement most likely reflects different underlying mechanisms across different intensive care presentations. The study cohort was intentionally designed to be heterogeneous in order to mirror a mixed, clinically representative intensive care unit population. Consequently, subgroup analyses performed by the investigators were exploratory in nature. Although the direction of association between reduced excursion and adverse outcomes was generally similar across the examined clinical subgroups, the resulting confidence intervals were wide, and statistical significance was not consistently retained following multivariable adjustment. Cavefors and Oras attributed this attenuation to the smaller sample sizes of individual subgroups and the resulting limited statistical power.

Despite the potential heterogeneity of the overall patient cohort, mitral annular plane systolic excursion remained prognostically informative across the studied population. Specifically, lower baseline measurements remained independently associated with ninety-day mortality after multivariable adjustments accounted for patient age, the Simplified Acute Physiology Score 3, and cardiac index. The authors pointed out that while mechanistic heterogeneity complicates annular excursion, this exact interpretive issue equally applies to conventional left ventricular ejection fraction in acute critical illness. Crucially, however, conventional ejection fraction failed to remain associated with ninety-day mortality once statistical adjustments were incorporated into the analysis. In addition, obtaining mitral annular displacement proved considerably more feasible to acquire in this critically ill cohort than completing biplane Simpson ejection fraction assessments.

The correspondence also detailed the rationale behind methodological decisions regarding patients presenting with mitral annular calcification, a structural condition recognized to influence echocardiographic annular displacement. Cavefors and Oras noted that although calcification can alter the mechanical interpretation of annular excursion, patients exhibiting this condition were purposefully not excluded from their investigation. Because the objective was to evaluate these measurements within a broad and clinically representative intensive care cohort, the researchers chose not to exclude patients solely on the basis of calcification. Furthermore, the authors explained that selective exclusion from the analysis would be difficult to justify, as annular calcification may be associated with broader impairments in longitudinal myocardial mechanics, including reductions in global longitudinal strain and systolic mitral annular tissue velocity.

Looking toward future research in the critical care setting, the investigators outlined necessary steps to refine the clinical interpretation of annular displacement. The authors suggested that larger prospective investigations incorporating prespecified aetiological strata, interaction analyses, and repeated echocardiographic evaluations over time may clarify whether the prognostic value and acquisition feasibility of annular excursion differ across specific intensive care populations.

In their concluding synthesis, Cavefors and Oras reiterated that their study findings should not be interpreted as supporting treatment strategies guided directly by mitral annular displacement. Rather, the reported data indicate that mitral annular plane systolic excursion captures clinically relevant prognostic information that is not fully reflected by conventional assessments of left ventricular ejection fraction. The authors maintained that the primary utility of this bedside metric lies in its meaningful contribution to integrated echocardiographic assessment and risk stratification in critically ill patients, providing practical prognostic insight while decisions regarding hemodynamic therapy continue to rest upon the holistic clinical status of the individual.

Subject of Research: Echocardiographic assessment of mitral annular plane systolic excursion in critical illness

Article Title: Response to: “MAPSE in critical illness: from prognostic association to clinical utility”

Article References: Cavefors, O., & Oras, J. (2026). Response to: “MAPSE in critical illness: from prognostic association to clinical utility”. Critical Care, 30(1), Article 541. https://doi.org/10.1186/s13054-026-06397-9

Image Credits: AI Generated

DOI: 10.1186/s13054-026-06397-9

Keywords: critical care, echocardiography, MAPSE, intensive care unit, left ventricular function, mortality risk, cardiac index, risk stratification, Response, critical, illness, prognostic