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

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• 作者：Lina De Geer (1)
  Jan Engvall (2)
  Anna Oscarsson (1)
  
  1. Department of Intensive Care Medicine ; Department of Medical and Health Sciences ; Link枚ping University ; 581 83 ; Link枚ping ; Sweden
  2. Department of Clinical Physiology ; Department of Medical and Health Sciences ; Link枚ping University ; 581 83 ; Link枚ping ; Sweden
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：960 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

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聽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鈥檚 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 (茅) and to amino-terminal pro-brain natriuretic peptide (NT-proBNP) (Spearman鈥檚 蟻 -0.70, 鈭?.53 and 0.54, and R2 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鈥?鈥?.05 and p鈥?鈥?.001, respectively), but not in GLPS, which remained unchanged over time (p鈥?鈥?.10). GLPS did not correlate to the improvement in clinical characteristics over time, did not differ significantly between survivors and non-survivors (鈭?7.4 (鈭?0.5-(鈭?3.7)) vs. -14.7 (鈭?9.0 - (鈭?0.6)), p鈥?鈥?.11), and could not predict mortality. Conclusions GLPS is frequently reduced in septic shock patients, alone or in combination with reduced LVEF and/or 茅. It correlates with LVEF, 茅 and NT-proBNP, and remains affected over time. GLPS may provide further understanding on the character of myocardial dysfunction in septic shock.