Left ventricular longitudinal wall fractional shortening accurately predicts longitudinal strain in critically ill patients with septic shock

Abstract

Background Left ventricular longitudinal strain (LVLS) may be a sensitive indicator of left ventricular (LV) systolic function in patients with sepsis, but is dependent on high image quality and analysis software. Mitral annular plane systolic excursion (MAPSE) and the novel left ventricular longitudinal wall fractional shortening (LV-LWFS) are bedside echocardiographic indicators of LV systolic function that are less dependent on image quality. Both are sparsely investigated in the critically ill population, and may potentially be used as surrogates for LVLS. We assessed if LVLS may be predicted by LV-LWFS and MAPSE in patients with septic shock. We also assessed the repeatability and inter-rater agreement of LVLS, LV-LWFS and MAPSE measurements. Results 122 TTE studies from 3 echocardiographic data repositories of patients admitted to ICU with septic shock were retrospectively assessed, of which 73 were suitable for LVLS analysis using speckle tracking. The correlations between LVLS vs. LV-LWFS and LVLS vs. MAPSE were 0.89 (p < 0.001) and 0.81 (p < 0.001) with mean squared errors of 5.8% and 9.1%, respectively. Using the generated regression equation, LV-LWFS predicted LVLS with a high degree of accuracy and precision, with bias and limits of agreement of -0.044 ± 4.7% and mean squared prediction error of 5.8%. Interobserver repeatability was good, with high intraclass correlation coefficients (0.96–0.97), small bias and tight limits of agreement (≤ 4.1% for all analyses) between observers for all measurements. Conclusions LV-LWFS may be used to estimate LVLS in patients with septic shock. MAPSE also performed well, but was slightly inferior compared to LV-LWFS in estimating LVLS. Feasibility of MAPSE and LV-LWFS was excellent, as was interobserver repeatability.

Incidence of acute myocardial injury and its association with left and right ventricular systolic dysfunction in critically ill COVID-19 patients

“…MAPSE has been demonstrated to be a principal contributor to LVEF [ 29 ] and is more sensitive in detecting LV dysfunction than EF in patients with cardiovascular disease [ 30 , 31 ]. Although GLS is considered a sensitive indicator of LV systolic function, previous studies have demonstrated the superior feasibility and utility of MAPSE for predicting left ventricular strain in the critically ill [ 32 , 33 ]. Since subendocardial myocardial fibres are longitudinal in orientation and most likely to be affected by oxygen demand-supply imbalances, there is a physiologic rationale to their association with myocardial injury especially within the context of hypoxaemic respiratory failure.…”

Mitral annular plane systolic excursion for assessing left ventricular systolic dysfunction in patients with septic shock

“… 21 , 26 In contrast, accurate measurements of LVEF or LVLS are dependent on the image resolution, in order to limit geometric and endocardial border assumptions. In a study of patients with sepsis, Johansson Blixt and colleagues 14 demonstrated that MAPSE was easy to measure. In contrast, Boissier and colleagues 25 demonstrated that even with trained operators, GLS was poorly feasible (in only 44% of cases) in the context of septic shock.…”

“…LV-LWFS is calculated from the MAPSE and the LV length, and therefore requires a standard ultrasound device only. Although Johansson Blixt and colleagues 14 observed a strong correlation between LV-LWFS and left ventricular longitudinal strain (LVLS) (especially in patients with septic shock), there are few published data concerning the correlation of LV-LWFS with LVEF.…”