Mitral Annular Plane Systolic Excursion as a Predictor of Mortality in Children With Septic Shock

Objectives: Myocardial dysfunction is well recognized in severe sepsis and septic shock. Echocardiography provides rapid, noninvasive, and bedside evaluation of cardiac function in patients with hemodynamic instability. Mitral annular plane systolic excursion is an M-mode–derived echocardiographic variable used to assess longitudinal left ventricular systolic function. No data are available about the uses of mitral annular plane systolic excursion in children with septic shock. Therefore, we aimed to assess the prognostic significance of mitral annular plane systolic excursion in children with septic shock and to correlate it with the most commonly used measures of left ventricular systolic function and myocardial injury. Design: A prospective cohort study. Setting: The study carried out at the PICU of Menoufia University Hospital in the period from March 2015 to September 2016. Patients: We serially enrolled 50 children with septic shock. Interventions: Complete diagnostic workup was performed for each patient including calculation of Pediatric Risk of Mortality III score. Transthoracic echocardiography was done to obtain mitral annular plane systolic excursion and the left ventricular ejection fraction measurement within 24 hours of inclusion then repeated on third and fifth days. Patients were followed up until hospital discharge or death. The predictive power of mitral annular plane systolic excursion was determined using the receiver operating characteristic curve. Measurements and Main Results: Mitral annular plane systolic excursion was significantly lower in nonsurvivors compared with survivors (p

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