Evaluating the effects of Esmolol on cardiac function in patients with Septic cardiomyopathy by Speck-tracking echocardiography—a randomized controlled trial

Abstract

Background Esmolol as one treatment of sepsis induced cardiomyopathy (SIC) is still controversial. The objective of this study is to evaluate cardiac function after reducing heart rate by Esmolol in patients with SIC using speck-tracking echocardiography. Methods This study was a single-center, prospective, and randomized controlled study. A total of 100 SIC patients with a heart rate more than 100/min, admitted to the Intensive Care Department of Tianjin Third Central Hospital from March 1, 2020 to September 30, 2021, were selected as the research subjects. They were randomly divided into the Esmolol group (Group E) and the conventional treatment group (Group C), each with 50 cases. The target heart rate of patients in Group E was controlled between 80/min and 100/min. Speck-tracking echocardiography (STE) and pulse indicating continuous cardiac output monitoring (PICCO) were performed in both groups at 1 h, 24 h, 48 h, 72 h, 96 h and 7 d after admission, with data concerning left ventricular global longitudinal strain (GLS), left ventricular ejection fraction (LVEF) and global ejection fraction (GEF), left ventricular systolic force index (dP/dtmx) were obtained, respectively. Hemodynamics and other safety indicators were monitored throughout the whole process. These subjects were followed up to 90 d, with their mortality recorded at Day 28 and Day 90, respectively. Statistical analyses were performed using SPSS version 21. Results With 24 h of Esmolol, all patients in Group E achieved the target heart rate, and there was no deterioration of GLS, or adverse events. However, compared with those in Group C, their GLS, GEF and dP/dtmx were increased, and the difference was statistically significant (P > 0.05). Compared with patients in Group C, those in Group E had lower short-term mortality, and logistic regression analysis also suggested that Esmolol improved patient outcomes. Conclusion In SIC patients, the application of Esmolol to lower heart rate decreased their short-term mortality while not making any impairment on the myocardial contractility. Trial registration Chinese Clinical Trial Registry, ChiCTR2100047513. Registered June 20, 2021- Retrospectively registered, http://www.chictr.org.cn/index.aspx. The study protocol followed the CONSORT guidelines. The study protocol was performed in the relevant guidelines.

The concomitant use of ultra short beta-blockers with vasopressors and inotropes in critically ill patients with septic shock: A systematic review and meta-analysis of randomized controlled trials

“…Specifically, the two studies with shorter ICU stays did not show significance in terms of 28-day mortality (J. Wang et al, 2023 ) or in-hospital mortality ( Cocchi et al, 2022 ). This finding may be due to the difference in the underlying clinical situation and disease severity among the included patients; in addition, both studies had a small sample size and investigated mortality as a secondary outcome.…”

“…Some of the included studies had predetermined heart rate targets below 100 beats/ min or below 95 beats/ min; however, the 28-day mortality benefit for these targets was controversial (H. Liu et al, 2019 , Morelli et al, 2013 ; J. Wang et al, 2023 ; S. Wang et al, 2017 ). In a previous study, an increased heart rate above 95 beats/min for more than 12 hours was associated with cardiac complications in critically ill patients in an ICU setting ( Sander et al, 2005 ).…”

“…In our meta-analysis, four studies underwent analysis, revealing mean lengths of ICU stays at approximately eight days ( Cocchi et al, 2022 ), 11 days (J. Wang et al, 2023 ), 14 days ( Xinqiang et al, 2015 ), and 19 days ( Morelli et al, 2013 ). Despite the mortality benefits observed in the analyzed studies, this advantage did not translate into a reduction in the duration of ICU stay.…”

“…We included two studies in the analysis and both studies used norepinephrine as the vasopressor of choice ( Cocchi et al, 2022 ; J. Wang et al, 2023 ). the first study showed that the mean difference in vasopressor dose requirements was significantly different between the esmolol group and control group at 12 h with higher vasopressor dose requirements in the esmolol group, but the difference was not significant at six hours and 24 hours with a decline in vasopressor dose requirement over the study time points ( Cocchi et al, 2022 ).…”

“…It is therefore imperative that these updated findings be taken into account for a more thorough and comprehensive analysis ( Cocchi et al, 2022 ; J. Wang et al, 2023 ). Including these studies might potentially alter the overall conclusions or effect sizes, leading to more precise estimates and a better understanding of the research question.…”