Left ventricular global longitudinal strain is independently associated with mortality in septic shock patients

Chang, Wei Ting; Lee, Wen Huang; Lee, Wei Ting; Chen, Po Sheng; Su, Yu Ru; Liu, Ping Yen; Liu, Yen Wen; Tsai, Wei Chuan

doi:10.1007/s00134-015-3970-3

Cited by 75 publications

(87 citation statements)

References 40 publications

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“…STE is an operator-independent technique with low inter-observer variability (from 2 [31] to 13% [32]) regarding strain data but higher variability regarding strain rate [28]. In patients with mechanical ventilation, we found an inter-observer variability of 8% [25] while others [20,24] have also found a good inter-observer agreement with a Bland-Altman analysis. STE could, therefore, provide objective data on systolic function with an acceptable variability.…”

Section: What Could Ste Add In the Icu Field?supporting

confidence: 50%

“…LV strain could, therefore, be used in septic shock as a surrogate marker of oxygenation deliverance inadequacy. To the best of our knowledge, one study pointed out that right ventricle strain impairment was associated with long-term mortality in septic shock [20] and a large mono-centric study of 111 patients pointed out that a GLS impairment ≥ −13% was the best marker of in-ICU mortality [24]. Our group published a mono-centric observational study about LV systolic function assessment with STE in patients with severe subarachnoid haemorrhage [25].…”

Section: Speckle-tracking In the Intensive Care Unitmentioning

confidence: 99%

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Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

Cinotti¹,

Delater²,

Fortuit³

et al. 2015

Anaesthesiol Intensive Ther

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Speckle-tracking analysis is a new available tool in order to assess left ventricular function in cardiology. Its novelty relies on the technological ability to track natural acoustic markers (known as speckle) within the myocardium during the cardiac cycle. This technology allows the evaluation of myocardium strain during systole and diastole. To date, global longitudinal strain (GLS) has been extensively studied in cardiology. It is now well established that GLS is more sensitive than left ventricular ejection fraction with 2D echocardiography in detecting systolic function impairment. It is also superior to left ventricular ejection fraction in the prediction of major cardio-vascular events. In the intensive care unit (ICU) setting, data are scarce. In experimental model and human studies in septic shock, speckle-tracking analysis suggests that GSL is impaired along with preserved left ventricular ejection fraction. Recent data also suggest that GLS impairment could predict in-ICU mortality in septic shock. In severe subarachnoid haemorrhage patients, speckle-tracking analysis could be more sensitive in detecting stress cardiomyopathy. However, there are many gaps to fill in the critically ill patient. For instance, the influence of mechanical ventilation on GLS is not fully elucidated, and there are, to date, too few data to exactly assess potential GLS alterations on the patient's outcome. Nonetheless, this new tool provides objective and sensitive data with acceptable intra and inter-observer variability and may be of primary interest in the evaluation of left-ventricular systolic function in the ICU.

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Section: What Could Ste Add In the Icu Field?supporting

confidence: 50%

Section: Speckle-tracking In the Intensive Care Unitmentioning

confidence: 99%

Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

Cinotti¹,

Delater²,

Fortuit³

et al. 2015

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

show abstract

“…The presence of myocardial depression, defined echocardiograpically (21)(22)(23)(24)(25) or by elevations in cardiac injury/dysfunction biomarkers such as troponin or B-type natriuretic peptide (26)(27)(28), is strongly associated with an increased mortality risk in septic patients. An important limitation in experimental studies proposing a role for mitochondria in septic cardiomyopathy is that they fail to consider the heterogeneity observed in human populations where patients may/may not develop septic cardiomyopathy.…”

Section: Introductionmentioning

confidence: 99%

Improved Survival in a Long-Term Rat Model of Sepsis Is Associated With Reduced Mitochondrial Calcium Uptake Despite Increased Energetic Demand

Pinto¹,

Dyson

Umbrello

et al. 2017

Critical Care Medicine

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Objective: To investigate the relationship between prognosis, changes in mitochondrial calcium uptake and bioenergetic status in the heart during sepsis. Design:In vivo and ex vivo controlled experimental studies.Setting: University research laboratory. Subjects: Male adult Wistar rats.Interventions: Sepsis was induced by intraperitoneal injection of fecal slurry. Shamoperated animals served as controls. Confocal microscopy was used to study functional and bioenergetic parameters in cardiomycoytes isolated after 24 h sepsis. Electron microscopy (EM) was used to characterize structural changes in mitochondria and sarcoplasmic reticulum. The functional response to dobutamine was assessed in vivo by echocardiography. Measurements and main results:Peak aortic blood flow velocity measured at 24 h was a good discriminator for 72 h survival (AUROC 0.84±0.1, p=0.03) and was used in ex vivo experiments at 24 h to identify septic animals with good prognosis.Measurements from animals with good prognostic showed i) a smaller increase in mitochondrial calcium content and in NADH fluorescence following pacing and ii) increased distance between mitochondria and SR on EM, and iii) NADH redox potential and ATP/ADP failed to reach a new steady state following pacing, suggesting impaired matching of energy supply and demand. In vivo, good prognosis animals had a blunted response to dobutamine with respect to stroke volume and kinetic energy. Conclusions:In situations of higher energetic demand decreased mitochondrial calcium uptake may constitute an adaptive cellular response that confers a survival advantage in response to sepsis at a cost of decreased oxidative capacity.4

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“…Another study has shown that the combination of global longitudinal strain (GLS) and the APACHE II score have additional value in the prediction of ICU and hospital mortality in septic shock patients admitted to the ICU [27]. STE may help in the early identification of high-risk patients in the ICU.…”

Section: Speckle Tracking Echocardiography (Ste)mentioning

confidence: 99%

Cardiac Ultrasonography in the critical care setting: a practical approach to asses cardiac function and preload for the “non-cardiologist”

Vermeiren¹,

Malbrain

Walpot³

2015

Anaesthesiol Intensive Ther

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Cardiac ultrasonography has become an indispensible tool in the management of hemodynamically unstable critically ill patients. Some consider it as the modern stethoscope. Echocardiography is non-invasive and safe while the modern portable devices allow to be used at the bedside in order to provide fast, specific and vital information regarding the hemodynamic status, as well as the function, structure and anatomy of the heart. In this review, we will give an overview of cardiac function in general followed by an assessment of left ventricular function using echocardiography with calculation of cardiac output, left ventricular ejection fraction (EF), fractional shortening, fractional area contraction, M mode EF, 2D planimetry and 3D volumetry. We will briefly discuss mitral annulus post systolic excursion (MAPSE), calculation of dP/dt, speckle tracking or eyeballing to estimate EF for the experienced user. In a following section, we will discuss how to assess cardiac preload and diastolic function in 4 simple steps. The first step is the assessment of systolic function. The next step assesses the left atrium. The third step evaluates the diastolic flow patterns and E/e' ratio. The final step integrates the information of the previous steps. Echocardiography is also the perfect tool to evaluate right ventricular function with tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging, together with inferior vena cava dimensions and systolic pulmonary artery pressure and right ventricular systolic pressure measurement. Finally, methods to assess fluid responsiveness with echocardiography are discussed with the inferior vena cava collapsibility index and the variation on left ventricle outflow tract peak velocity and velocity time integral. Cardiac ultrasonography is an indispensible tool for the critical care physician to assess cardiac preload, afterload and contractile function in hemodynamically unstable patients in order to fine-tune treatment with fluids, inotropes and/or vasopressors.

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Left ventricular global longitudinal strain is independently associated with mortality in septic shock patients

Abstract: These findings suggest that combining GLS and the APACHE II score has additive value in the prediction of ICU and hospital mortalities and that GLS may help in early identification of high-risk septic shock patients in ICU.

Cited by 75 publications

References 40 publications

Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

Improved Survival in a Long-Term Rat Model of Sepsis Is Associated With Reduced Mitochondrial Calcium Uptake Despite Increased Energetic Demand

Cardiac Ultrasonography in the critical care setting: a practical approach to asses cardiac function and preload for the “non-cardiologist”

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