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Strain echocardiography in septic shock - a comparison with systolic and diastolic function parameters, cardiac biomarkers and outcome.

De Geer L, Engvall J, Oscarsson A - Crit Care (2015)

Bottom Line: The correlation of GLPS to left ventricular systolic and diastolic function parameters, cardiac biomarkers and clinical data were compared using Spearman's correlation test and linear regression analysis, and the ability of GLPS to predict outcome was evaluated using a logistic regression model.In LVEF and NT-proBNP there was a significant improvement during the study period (analysis of variance (ANOVA) with repeated measures, p = 0.05 and p < 0.001, respectively), but not in GLPS, which remained unchanged over time (p = 0.10).GLPS did not correlate to the improvement in clinical characteristics over time, did not differ significantly between survivors and non-survivors (-17.4 (-20.5-(-13.7)) vs. -14.7 (-19.0 - (-10.6)), p = 0.11), and could not predict mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Intensive Care Medicine, Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden. lina.de.geer@regionostergotland.se.

ABSTRACT

Introduction: Myocardial dysfunction is a well-known complication in septic shock but its characteristics and frequency remains elusive. Here, we evaluate global longitudinal peak strain (GLPS) of the left ventricle as a diagnostic and prognostic tool in septic shock.

Methods: Fifty adult patients with septic shock admitted to a general intensive care unit were included. Transthoracic echocardiography was performed on the first day, and repeated during and after ICU stay. Laboratory and clinical data and data on outcome were collected daily from admission and up to 7 days, shorter in cases of death or ICU discharge. The correlation of GLPS to left ventricular systolic and diastolic function parameters, cardiac biomarkers and clinical data were compared using Spearman's correlation test and linear regression analysis, and the ability of GLPS to predict outcome was evaluated using a logistic regression model.

Results: On the day of admission, there was a strong correlation and co-linearity of GLPS to left ventricular ejection fraction (LVEF), mitral annular motion velocity (é) and to amino-terminal pro-brain natriuretic peptide (NT-proBNP) (Spearman's ρ -0.70, -0.53 and 0.54, and R(2) 0.49, 0.20 and 0.24, respectively). In LVEF and NT-proBNP there was a significant improvement during the study period (analysis of variance (ANOVA) with repeated measures, p = 0.05 and p < 0.001, respectively), but not in GLPS, which remained unchanged over time (p = 0.10). GLPS did not correlate to the improvement in clinical characteristics over time, did not differ significantly between survivors and non-survivors (-17.4 (-20.5-(-13.7)) vs. -14.7 (-19.0 - (-10.6)), p = 0.11), and could not predict mortality.

Conclusions: GLPS is frequently reduced in septic shock patients, alone or in combination with reduced LVEF and/or é. It correlates with LVEF, é and NT-proBNP, and remains affected over time. GLPS may provide further understanding on the character of myocardial dysfunction in septic shock.

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Related in: MedlinePlus

Clinical spectrum and distribution of myocardial dysfunction on day 1 in studied patients. Data are presented as number (percentage). LVEF, left ventricular ejection fraction; global longitudinal peak strain; é, early mitral tissue Doppler velocity; E/é, ratio of early mitral inflow (E) to é.
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Fig1: Clinical spectrum and distribution of myocardial dysfunction on day 1 in studied patients. Data are presented as number (percentage). LVEF, left ventricular ejection fraction; global longitudinal peak strain; é, early mitral tissue Doppler velocity; E/é, ratio of early mitral inflow (E) to é.

Mentions: Overall 31 patients (70%) had LV dysfunction at the first examination. Decreased GLPS was seen in 18 patients (41%), whereas decreased LVEF was present in 22 patients (50%). Signs of diastolic dysfunction with decreased é velocity or increased E/é ratio were present in 18 patients (41%). As shown in Figure 1, there was marked overlap between groups, with 15 patients (34%) having decreased GLPS as well as decreased LVEF and/or diastolic dysfunction. Of those examined a second time, that is, alive but not yet discharged, there was LV dysfunction in 16 patients (62%), all of whom had decreased GLPS in combination with other echocardiographic signs of myocardial dysfunction.Figure 1


Strain echocardiography in septic shock - a comparison with systolic and diastolic function parameters, cardiac biomarkers and outcome.

De Geer L, Engvall J, Oscarsson A - Crit Care (2015)

Clinical spectrum and distribution of myocardial dysfunction on day 1 in studied patients. Data are presented as number (percentage). LVEF, left ventricular ejection fraction; global longitudinal peak strain; é, early mitral tissue Doppler velocity; E/é, ratio of early mitral inflow (E) to é.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4374340&req=5

Fig1: Clinical spectrum and distribution of myocardial dysfunction on day 1 in studied patients. Data are presented as number (percentage). LVEF, left ventricular ejection fraction; global longitudinal peak strain; é, early mitral tissue Doppler velocity; E/é, ratio of early mitral inflow (E) to é.
Mentions: Overall 31 patients (70%) had LV dysfunction at the first examination. Decreased GLPS was seen in 18 patients (41%), whereas decreased LVEF was present in 22 patients (50%). Signs of diastolic dysfunction with decreased é velocity or increased E/é ratio were present in 18 patients (41%). As shown in Figure 1, there was marked overlap between groups, with 15 patients (34%) having decreased GLPS as well as decreased LVEF and/or diastolic dysfunction. Of those examined a second time, that is, alive but not yet discharged, there was LV dysfunction in 16 patients (62%), all of whom had decreased GLPS in combination with other echocardiographic signs of myocardial dysfunction.Figure 1

Bottom Line: The correlation of GLPS to left ventricular systolic and diastolic function parameters, cardiac biomarkers and clinical data were compared using Spearman's correlation test and linear regression analysis, and the ability of GLPS to predict outcome was evaluated using a logistic regression model.In LVEF and NT-proBNP there was a significant improvement during the study period (analysis of variance (ANOVA) with repeated measures, p = 0.05 and p < 0.001, respectively), but not in GLPS, which remained unchanged over time (p = 0.10).GLPS did not correlate to the improvement in clinical characteristics over time, did not differ significantly between survivors and non-survivors (-17.4 (-20.5-(-13.7)) vs. -14.7 (-19.0 - (-10.6)), p = 0.11), and could not predict mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Intensive Care Medicine, Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden. lina.de.geer@regionostergotland.se.

ABSTRACT

Introduction: Myocardial dysfunction is a well-known complication in septic shock but its characteristics and frequency remains elusive. Here, we evaluate global longitudinal peak strain (GLPS) of the left ventricle as a diagnostic and prognostic tool in septic shock.

Methods: Fifty adult patients with septic shock admitted to a general intensive care unit were included. Transthoracic echocardiography was performed on the first day, and repeated during and after ICU stay. Laboratory and clinical data and data on outcome were collected daily from admission and up to 7 days, shorter in cases of death or ICU discharge. The correlation of GLPS to left ventricular systolic and diastolic function parameters, cardiac biomarkers and clinical data were compared using Spearman's correlation test and linear regression analysis, and the ability of GLPS to predict outcome was evaluated using a logistic regression model.

Results: On the day of admission, there was a strong correlation and co-linearity of GLPS to left ventricular ejection fraction (LVEF), mitral annular motion velocity (é) and to amino-terminal pro-brain natriuretic peptide (NT-proBNP) (Spearman's ρ -0.70, -0.53 and 0.54, and R(2) 0.49, 0.20 and 0.24, respectively). In LVEF and NT-proBNP there was a significant improvement during the study period (analysis of variance (ANOVA) with repeated measures, p = 0.05 and p < 0.001, respectively), but not in GLPS, which remained unchanged over time (p = 0.10). GLPS did not correlate to the improvement in clinical characteristics over time, did not differ significantly between survivors and non-survivors (-17.4 (-20.5-(-13.7)) vs. -14.7 (-19.0 - (-10.6)), p = 0.11), and could not predict mortality.

Conclusions: GLPS is frequently reduced in septic shock patients, alone or in combination with reduced LVEF and/or é. It correlates with LVEF, é and NT-proBNP, and remains affected over time. GLPS may provide further understanding on the character of myocardial dysfunction in septic shock.

Show MeSH
Related in: MedlinePlus