Mitral annular plane systolic excursion as a prognostic marker in critical illness: A systematic review and meta-analysis

Cardiac dysfunction is common in critical illness, yet conventional indices such as left ventricular ejection fraction (LVEF) may fail to detect early impairment. Mitral annular plane systolic excursion (MAPSE), a marker of longitudinal function, may provide prognostic information, but its role in critical illness remains uncertain. PubMed, Embase, and Cochrane Library were searched for studies evaluating MAPSE in critically ill adults. Studies were included if MAPSE could be dichotomized using prespecified cutoffs (10 or 12 mm). The primary outcome was in-hospital mortality; secondary outcomes included 28-30-day mortality and exploratory measures of cardiac function and organ support. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled. Risk of bias was assessed with QUIPS and certainty of evidence with GRADE. Ten observational studies including 1313 patients were analyzed; 414 (31.5%) had reduced MAPSE. Most patients had sepsis or septic shock. Reduced MAPSE was associated with higher in-hospital mortality (37.7% vs 11.7%; RR 4.81; 95% CI 1.28-18.04; p = 0.02; I2 = 70.6%), with consistent effects across both cutoffs (p = 0.111) and adequate information size on trial sequential analysis. Reduced MAPSE was also associated with lower LVEF (MD -13.0%; 95% CI -20.6 to -5.4; p < 0.01; I2 = 94.6%), but not with 28-30-day mortality or exploratory outcomes. Certainty of evidence was low for in-hospital mortality and very low for secondary and exploratory outcomes. Reduced MAPSE was associated with higher in-hospital mortality and may be a bedside marker of myocardial dysfunction. Given the limitations of the available evidence, MAPSE remains a hypothesis-generating marker requiring prospective validation.