Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock: a systematic review and meta-analysis

Abstract

BackgroundSepsis-induced myocardial dysfunction is associated with poor outcomes, but traditional measurements of systolic function such as left ventricular ejection fraction (LVEF) do not directly correlate with prognosis. Global longitudinal strain (GLS) utilizing speckle-tracking echocardiography (STE) could be a better marker of intrinsic left ventricular (LV) function, reflecting myocardial deformation rather than displacement and volume changes. We sought to investigate the prognostic value of GLS in patients with sepsis and/or septic shock.MethodsWe conducted a systematic review (PubMed and Embase up to 26 October 2017) and meta-analysis to investigate the association between GLS and mortality at longest follow up in patients with severe sepsis and/or septic shock. In the primary analysis, we included studies reporting transthoracic echocardiography data on GLS according to mortality. A secondary analysis evaluated the association between LVEF and mortality including data from studies reporting GLS.ResultsWe included eight studies in the primary analysis with a total of 794 patients (survival 68%, n = 540). We found a significant association between worse LV function and GLS values and mortality: standard mean difference (SMD) − 0.26; 95% confidence interval (CI) − 0.47, − 0.04; p = 0.02 (low heterogeneity, I2 = 43%). No significant association was found between LVEF and mortality in the same population of patients (eight studies; SMD, 0.02; 95% CI − 0.14, 0.17; p = 0.83; no heterogeneity, I2 = 3%).ConclusionsWorse GLS (less negative) values are associated with higher mortality in patients with severe sepsis or septic shock, while such association is not valid for LVEF. More critical care research is warranted to confirm the better ability of STE in demonstrating underlying intrinsic myocardial disease compared to LVEF.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2113-y) contains supplementary material, which is available to authorized users.

Targeting the eCIRP/TREM-1 Interaction with a Small Molecule Inhibitor Improves Cardiac Dysfunction in Neonatal Sepsis

“…[72] In a meta-analysis of adult patients with sepsis, increased (i.e., less negative) global longitudinal strain values were associated with mortality; this nding was not seen with ejection fraction -the most commonly used parameter to evaluate adult cardiac function in sepsis. [73] Additionally, changes in myocardial strain have been shown to correlate with the upregulation of in ammatory cytokines and mitochondrial dysfunction in the form of an increased in mitochondrial ROS. [72] In our study, eCIRP worsened both longitudinal and radial cardiac strain, providing direct evidence that eCIRP causes cardiac dysfunction in neonatal sepsis.…”

Is Left Ventricular Global Longitudinal Strain by Two-Dimensional Speckle Tracking Echocardiography in Sepsis Cardiomyopathy ready for prime time use in the ICU?

“…Several recent studies and a review/meta-analysis 11 shed light on the important question; is GLS is a better predictor of mortality in sepsis cardiomyopathy than the traditional parameter; LV ejection fraction. In their meta-analysis [ 11 ], the authors pooled available and eligible observational studies that included 794 patients with severe sepsis and/or septic shock.…”

Prechemotherapy subclinical left ventricular dysfunction: Do we know the mechanism?

“…In a meta‐analysis of 8 studies involving 794 patients, there was a significant association between the worse LV function and GLS values and mortality (standard mean difference −0.26; 95% CI‐ 0.47, −0.04, P ‐ .02) in patients with severe sepsis/and or septic shock. There was no association between LVEF and mortality in the same population of patients . Therefore, the mechanism leading to prechemotherapy changes in the LV systolic function is still elusive.…”