Left Ventricular Systolic Longitudinal Function as Predictor of Outcome in Patients With Sepsis

Abstract

In patients with sepsis assisted in a high-dependency observational unit, feasibility of assessments of left ventricular EF and GLS within 24 h from the hospitalization was acceptable and EF showed no prognostic relevance, whereas GLS showed a correlation with mortality rate potentially relevant in shorter more than in longer follow-ups.

Assessing Contractile Function When Ejection Fraction Is Normal

“…14 Recent studies have demonstrated that a impaired myocardial deformation, as assessed by low GLS, seems to provide incremental prognostic information to LVEF about the risk of cardiovascular morbidity and mortality, especially when LVEF is relatively preserved. 3,4,6 Similar results are presented in the current issue of Circulation: Cardiovascular Imaging, where Palmieri et al 15 report an interesting article, which aims to investigate whether GLS provide incremental prognostic information in patients admitted to a subintensive medical unit with severe sepsis or septic shock. 15 This prospective study included 115 patients admitted to a single subintensive medical unit, who had an echocardiogram performed within 24 hours of admission.…”

“…3,4,6 Similar results are presented in the current issue of Circulation: Cardiovascular Imaging, where Palmieri et al 15 report an interesting article, which aims to investigate whether GLS provide incremental prognostic information in patients admitted to a subintensive medical unit with severe sepsis or septic shock. 15 This prospective study included 115 patients admitted to a single subintensive medical unit, who had an echocardiogram performed within 24 hours of admission. Follow-up on mortality was assessed at 7 and 28 days after admission.…”

“…In patients with low LVEF, both GLS and LVEF were capable in identifying patients in high risk of mortality, but in the high LVEF spectra, fatal events were distributed across a wide range of LVEFs, whereas almost all deceased patients had GLS<15%, despite relatively preserved LVEF. 15 Besides being the largest prospective study assessing the usefulness of GLS to predict outcome in patients with sepsis, the authors also display, like other reports have done previously, 3,4,6 that GLS especially seems to provide incremental information about outcomes in the setting of a preserved LV systolic function as assessed by LVEF. Therefore, when LVEF is low, all cardiologist are well aware that the patient is at high risk, however, when LVEF is preserved, we need additional and other information about cardiac function, and GLS might be the clinical tool to use.…”

“…3,4, 6 Palmieri et al 15 add yet another clinical disease to the continued expanding list of diseases, where assessing LV longitudinal deformation might improve risk stratification. In addition, the authors also add to the increasing evidence demonstrating that LV longitudinal deformation identifies subtle cardiac dysfunction, regardless of LVEF, which provides prognostic information above and beyond what we can obtain from our conventional echocardiographic measures, and further supports the argument that it may be time to move beyond LVEF in assessment of cardiac function.…”

Application of Cardiovascular Mechanics to Risk Stratification in End Stage Renal Disease

“…Although not large (198 evaluable subjects) and restricted to a single centre, this is the largest series to combine both measures and it is worth emphasising that this was a high-risk population. Almost 40% were diabetic and more than a quarter had an existing diagnosis of coronary artery disease.GLS using speckle tracking echocardiography has an expanding role in cardiology practice and has proved to be superior to left ventricular ejection fraction (LVEF) in predicting outcomes in situations as diverse as sepsis [2] , heart failure with preserved ejection fraction [3] and late after cardiotoxic chemotherapy [4] . As such, it is part of the repertoire of many cardiology departments.…”