Speckle tracking echocardiography in patients with septic shock: a case control study (SPECKSS)

Abstract

BackgroundSepsis-induced myocardial dysfunction is a well-recognized condition and confers worse outcomes in septic patients. Echocardiographic assessment by conventional parameters such as left ventricular ejection fraction (LVEF) is often affected by ongoing changes in preload and afterload conditions. Novel echocardiographic technologies such as speckle tracking echocardiography (STE) have evolved for direct assessment of the myocardial function. We investigate the measurement of myocardial strain by speckle tracking echocardiography for the diagnosis of sepsis-induced myocardial dysfunction.MethodsThis is a case-control study at a university-affiliated medical intensive care unit. Consecutive adult medical patients admitted with a diagnosis of septic shock were included. Patients with other causes of myocardial dysfunction were excluded. They were compared to age-matched, gender-matched, and cardiovascular risk-factor-matched controls, who were admitted to hospital for sepsis but did not develop septic shock. Transthoracic echocardiography was performed on all patients within 24 hours of diagnosis, and a reassessment echocardiogram was performed in the study group of patients upon recovery.ResultsPatients with septic shock (n = 33) (study group) and 29 matched patients with sepsis but no septic shock (control group) were recruited. The mean sequential organ failure assessment (SOFA) score for the study and control groups were 10.2 and 1.6, respectively (P < 0.001). In patients with septic shock, the mean arterial pressure was lower (76 mmHg vs 82 mmHg, P = 0.032), and the heart rate was higher (99 bpm vs 86 bpm, P = 0.008). The cardiac output (5.9 L/min vs 5.5 L/min, P = 0.401) and systemic vascular resistance (1090 dynes•sec/cm5 vs 1194 dynes•sec/cm5, P = 0.303) were similar. The study group had a greater degree of myocardial dysfunction measured by global longitudinal strain (GLS) (–14.5 % vs –18.3 %, P <0.001), and the myocardial strain differed upon diagnosis and recovery (–14.5 % vs –16.0 %, P = 0.010). Conventional echocardiographic measurements such as LVEF (59 % in the study group vs 61 % in the control group, P = 0.169) did not differ between the two groups.ConclusionSpeckle tracking echocardiography can detect significant left ventricular impairment in patients with septic shock, which was not otherwise detectable by conventional echocardiography. The reversible nature of myocardial dysfunction in sepsis was also demonstrable. This echocardiographic technique is useful in the diagnosis and monitoring of sepsis-induced myocardial dysfunction.

Subclinical anthracycline‐induced cardiotoxicity in long‐term follow‐up of asymptomatic childhood cancer survivors: Assessment by speckle tracking echocardiography

“…Further, using this method, some studies showed reduced inter‐ and intra‐observer variability in assessing regional LV function . Additionally, compared to LVEF, STE is affected to a much lesser degree by changes of ventricular loading conditions, myocardial compliance, and afterload properties because it measures deformation directly …”

“…22 Additionally, compared to LVEF, STE is affected to a much lesser degree by changes of ventricular loading conditions, myocardial compliance, and afterload properties because it measures deformation directly. 23 As strain values are shown to reveal subclinical disease in different morbidities, it might also be useful in early detection of subclinical heart failure in anthracycline-treated patients. 17 Mavinkurve-Groothuis et al 24 showed that global myocardial strain and strain rate in asymptomatic survivors of childhood cancer were fibers are the most sensitive and vulnerable to myocardial disease.…”

Contemporary perioperative haemodynamic monitoring

“…The slope of the regional stretch-strain relationship measured from tissue Doppler imaging (TDI) can be used as a noninvasive index of the myocardial inotropic state, but cannot be used in patients with atrial arrhythmias or high heart rates with fusion of mitral inflow E and A waves [120]. Recently, non-invasive speckle tracking echocardiography (STE) allowed combined regional and global myocardial function assessment [123,124]. Global peak longitudinal strain (GLS), determined from STE, is a sensitive and feasible method, which overcomes many of the limitations of LVEF.…”

Septic cardiomyopathy : pathophysiology and prognosis

“…(16) A recent study using STE in patients on the ICU with septic shock concluded that it is capable of detecting significant LV impairment which was not detectable by conventional echocardiographic techniques and also that the ventricular dysfunction is reversible in patients who survive their episode of sepsis. (17) Total isovolaemic time measures global LV electromechanical dys-synchrony & this is both common and associated with an increased mortality. Echocardiographically guided re-synchronisation therapy may significantly improve cardiac output in patents with septic shock and severe heart failure requiring high doses of vasopressors.…”