Global longitudinal strain changes during hemorrhagic shock: An experimental study

BACKGROUND Peri-operative and critically ill patients often experience mild to moderate hypovolaemic shock with preserved mean arterial pressure (MAP), heart rate (HR) and decreased stroke volume index (SVI). OBJECTIVES The aim of this study was to evaluate echocardiographic parameters during simulated mild to moderate central hypovolaemia. DESIGN This was a prospective preclinical study. SETTING Laboratory trial performed in Charité-Universitätsmedizin Berlin, Germany. PATIENTS AND METHODS Thirty healthy male volunteers underwent graded central hypovolaemia using a lower body negative pressure (LBNP) chamber with a stepwise decrease to simulate a mild (−15 mmHg), mild-to-moderate (−30 mmHg), and moderate state of hypovolaemic shock (−45 mmHg). During every stage, a transthoracic echocardiography examination (TTE) was performed by a certified examiner. MAIN OUTCOME MEASURES Systolic and diastolic myocardial performance markers, as well as cardiac volumes were recorded during simulated hypovolaemia and compared to baseline values. RESULTS During simulated hypovolaemia via LBNP, SVI decreased progressively at all stages, whereas MAP and HR did not consistently change. Left ventricular (LV) ejection fraction decreased at −30 and −45 mmHg. Simultaneously with SVI decline, LV global longitudinal strain (LV GLS), tricuspid annular plain systolic excursion (TAPSE), and right ventricular RV S’ and left-atrial end-systolic volume (LA ESV) decreased compared to baseline at all stages. CONCLUSIONS In this study, simulated central hypovolaemia using LBNP did not induce consistent changes in MAP and HR. SVI decreased and was associated with deteriorated right- and left-ventricular function, observed with echocardiography. The decreased filling status was characterised by decreased LA ESV. CLINICAL TRIAL NUMBER ClinicalTrials.gov Identifier: NCT03481855.

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A comprehensive echocardiographic analysis during simulated hypovolaemia

Feldheiser

Juhl-Olsen

Nordine

et al. 2023

European Journal of Anaesthesiology

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Can blood loss be assessed by echocardiography? An experimental study on a controlled hemorrhagic shock model in piglets

Grau-Mercier

Coisy

Markarian

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND: Assessment of the volemic loss is a major challenge during the management of hemorrhagic shock. Echocardiography is an increasingly used noninvasive tool for hemodynamic assessment. In mechanically ventilated patients, some studies suggest that respiratory variations of mean subaortic time-velocity integral (ΔVTI) would be predictive of fluid filling response. An experimental model of controlled hemorrhagic shock provides a precise approach to study correlation between blood volume and cardiac ultrasonographic parameters. OBJECTIVES:The main objective was to analyze the ΔVTI changes during hemorrhage in an anesthetized-piglet model of controlled hemorrhagic shock.The secondary objective was to evaluate ΔVTI during the resuscitation process after hemorrhage and other echocardiographic parameters changes during the whole protocol. METHODS:Twenty-four anesthetized and ventilated piglets were bled until mean arterial pressure reached 40 mm Hg. Controlled hemorrhage was maintained for 30 minutes before randomizing the piglets to two resuscitation groups: fluid filling group resuscitated with saline solution and noradrenaline group resuscitated with saline solution and noradrenaline. Echocardiography and hemodynamic measures, including pulsed pressure variations (PPV), were performed at different stages of the protocol. RESULTS:The correlation coefficient between ΔVTI and PPV with the volume of bleeding during the hemorrhagic phase were respectively 0.24 (95% confidence interval ,0.08-0.39; p < 0.01) and 0.57 (95% CI, 0.44-0.67; p < 0.01). Two parameters had a moderate correlation coefficient with hemorrhage volume (over 0.5): mean subaortic time-velocity index (VTI) and mitral annulus diastolic tissular velocity (E′). CONCLUSION: In this hemorrhagic shock model, ΔVTI had a low correlation with the volume of bleeding, but VTI and E′ had a correlation with blood volume comparable to that of PPV.

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Assessment of left ventricle myocardial deformation in a hemorrhagic shock swine model by two-dimensional speckle tracking echocardiography

Vasconcellos

Saad

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND: Trauma-induced secondary cardiac injury has been associated with significant adverse cardiovascular events. Speckle tracking echocardiography is a novel technology that allows an accurate and reproducible cardiac structure and function assessment. We evaluated the left ventricle (LV) myocardial deformation by speckle tracking echocardiography in a hemorrhagic shock (HS) swine model. METHODS:Seven healthy male Landrace pigs were included in this study. Severe HS was reached through three sequentially blood withdraws of 20% of estimated blood volume, and it was maintained for 60 minutes. Volume resuscitation was performed using all precollected blood volume.A 1.8-to 4.2-MHz phased-array transducer was used to acquire the two-dimensional echocardiography images. Strain measurements were obtained semiautomatically by wall motion tracking software. Results are presented as medians and interquartile ranges and compared using Wilcoxon rank-sum test. A p value of <0.05 was considered statistically significant. RESULTS:The median weight was 32 (26.1-33) kg, and the median total blood volume withdrawn was 1,100 (1,080-1,190) mL. During the severe HS period, the median arterial systemic pressure was 39 (36-46) mm Hg, and the cardiac index was 1.7 (1.6-2.0) L/min/m 2 . There was statistically significant absolute decrease in the global longitudinal strain 2 hours postresuscitation comparing with the basal measurements (−9.6% [−10.7 to −8.0%] vs. −7.9% [−8.1 to −7.4%], p = 0.03). There were no statistically significant differences between the basal and 2 hours postresuscitation assessments in the invasive/noninvasive hemodynamic, other two-dimensional echocardiogram (LVejection fraction, 49.2% [44-54.3%] vs. 53.2% [51.5-55%]; p = 0.09), and circumferential strain (−10.6% [−14.4 to −9.0%] vs. −8.5% [−8.6 to −5.2%], p = 0.06) parameters. CONCLUSION: In this experimental swine model of controlled HS, LV global longitudinal strain analysis accurately characterizes the timing and magnitude of subclinical cardiac dysfunction associated with trauma-induced secondary cardiac injury.

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Global longitudinal strain changes during hemorrhagic shock: An experimental study

Cited by 4 publications

References 18 publications

A comprehensive echocardiographic analysis during simulated hypovolaemia

A comprehensive echocardiographic analysis during simulated hypovolaemia

Can blood loss be assessed by echocardiography? An experimental study on a controlled hemorrhagic shock model in piglets

Assessment of left ventricle myocardial deformation in a hemorrhagic shock swine model by two-dimensional speckle tracking echocardiography

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