Outcome prediction in sepsis: Speckle tracking echocardiography based assessment of myocardial function

Orde, Sam; Pulido, Juan N.; Miyamoto, Masaki; Gillespie, Shane; Spoon, Jocelyn; Kane, Garvan C.; Oh, Jae K.

doi:10.1186/cc13987

Cited by 154 publications

(192 citation statements)

References 33 publications

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“…STE is an operator-independent technique with low inter-observer variability (from 2 [31] to 13% [32]) regarding strain data but higher variability regarding strain rate [28]. In patients with mechanical ventilation, we found an inter-observer variability of 8% [25] while others [20,24] have also found a good inter-observer agreement with a Bland-Altman analysis. STE could, therefore, provide objective data on systolic function with an acceptable variability.…”

Section: What Could Ste Add In the Icu Field?supporting

confidence: 49%

“…Apical segments display a preserved strain in this patient victim of a severe subarachnoid haemorrhage (personal data) the authors found a severe longitudinal strain impairment along with preserved LVEF [19]. In 60 patients with septic shock, the authors found systolic function impairment in 69% of patients assessed with STE, whereas only 33% patients displayed LVEF alteration [20]. In another cohort of 50 patients with septic shock, the authors also described a preserved LVEF when LV global longitudinal peak strain was altered [21].…”

Section: Speckle-tracking In the Intensive Care Unitmentioning

confidence: 75%

“…LV strain could, therefore, be used in septic shock as a surrogate marker of oxygenation deliverance inadequacy. To the best of our knowledge, one study pointed out that right ventricle strain impairment was associated with long-term mortality in septic shock [20] and a large mono-centric study of 111 patients pointed out that a GLS impairment ≥ −13% was the best marker of in-ICU mortality [24]. Our group published a mono-centric observational study about LV systolic function assessment with STE in patients with severe subarachnoid haemorrhage [25].…”

Section: Speckle-tracking In the Intensive Care Unitmentioning

confidence: 99%

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Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

Cinotti¹,

Delater²,

Fortuit³

et al. 2015

Anaesthesiol Intensive Ther

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Speckle-tracking analysis is a new available tool in order to assess left ventricular function in cardiology. Its novelty relies on the technological ability to track natural acoustic markers (known as speckle) within the myocardium during the cardiac cycle. This technology allows the evaluation of myocardium strain during systole and diastole. To date, global longitudinal strain (GLS) has been extensively studied in cardiology. It is now well established that GLS is more sensitive than left ventricular ejection fraction with 2D echocardiography in detecting systolic function impairment. It is also superior to left ventricular ejection fraction in the prediction of major cardio-vascular events. In the intensive care unit (ICU) setting, data are scarce. In experimental model and human studies in septic shock, speckle-tracking analysis suggests that GSL is impaired along with preserved left ventricular ejection fraction. Recent data also suggest that GLS impairment could predict in-ICU mortality in septic shock. In severe subarachnoid haemorrhage patients, speckle-tracking analysis could be more sensitive in detecting stress cardiomyopathy. However, there are many gaps to fill in the critically ill patient. For instance, the influence of mechanical ventilation on GLS is not fully elucidated, and there are, to date, too few data to exactly assess potential GLS alterations on the patient's outcome. Nonetheless, this new tool provides objective and sensitive data with acceptable intra and inter-observer variability and may be of primary interest in the evaluation of left-ventricular systolic function in the ICU.

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Section: What Could Ste Add In the Icu Field?supporting

confidence: 49%

Section: Speckle-tracking In the Intensive Care Unitmentioning

confidence: 75%

Section: Speckle-tracking In the Intensive Care Unitmentioning

confidence: 99%

See 1 more Smart Citation

Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

Cinotti¹,

Delater²,

Fortuit³

et al. 2015

Anaesthesiol Intensive Ther

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“…Furthermore, a greater portion of the patients in this study were identified as having systolic dysfunction of both the RV and LV when assessed by STE as compared with conventional echocardiography [26].…”

Section: Speckle Tracking Echocardiography (Ste)mentioning

confidence: 87%

Cardiac Ultrasonography in the critical care setting: a practical approach to asses cardiac function and preload for the “non-cardiologist”

Vermeiren¹,

Malbrain

Walpot³

2015

Anaesthesiol Intensive Ther

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Cardiac ultrasonography has become an indispensible tool in the management of hemodynamically unstable critically ill patients. Some consider it as the modern stethoscope. Echocardiography is non-invasive and safe while the modern portable devices allow to be used at the bedside in order to provide fast, specific and vital information regarding the hemodynamic status, as well as the function, structure and anatomy of the heart. In this review, we will give an overview of cardiac function in general followed by an assessment of left ventricular function using echocardiography with calculation of cardiac output, left ventricular ejection fraction (EF), fractional shortening, fractional area contraction, M mode EF, 2D planimetry and 3D volumetry. We will briefly discuss mitral annulus post systolic excursion (MAPSE), calculation of dP/dt, speckle tracking or eyeballing to estimate EF for the experienced user. In a following section, we will discuss how to assess cardiac preload and diastolic function in 4 simple steps. The first step is the assessment of systolic function. The next step assesses the left atrium. The third step evaluates the diastolic flow patterns and E/e' ratio. The final step integrates the information of the previous steps. Echocardiography is also the perfect tool to evaluate right ventricular function with tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging, together with inferior vena cava dimensions and systolic pulmonary artery pressure and right ventricular systolic pressure measurement. Finally, methods to assess fluid responsiveness with echocardiography are discussed with the inferior vena cava collapsibility index and the variation on left ventricle outflow tract peak velocity and velocity time integral. Cardiac ultrasonography is an indispensible tool for the critical care physician to assess cardiac preload, afterload and contractile function in hemodynamically unstable patients in order to fine-tune treatment with fluids, inotropes and/or vasopressors.

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“…With the Introduction systolic and diastolic function, of the heart. Numerous studies on septic cardiac dysfunction have described systolic as well as diastolic dysfunction, or a combination of the two, using a variety of different echocardiographic parameters (22,23,33). Since a reduced LVEF is the most commonly used definition of septic cardiac dysfunction, echocardiographic studies have mainly concerned the systolic function of the heart.…”

Section: Cardiac Function Imaging In Sepsismentioning

confidence: 99%

Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

Geer

2016

Linköping University Medical Dissertations

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Background: Cardiac dysfunction is a well-known complication of sepsis, but its characteristics and consequences, especially on a longer term, remain unclear. The aim of this thesis was to study the characteristics and the implications of cardiac dysfunction for outcome in intensive care unit (ICU) patients with septic shock. Purpose: First, to assess the ability of a cardiac biomarker to predict outcome in ICU patients. Second, to characterise cardiac dysfunction in septic shock using speckle tracking echocardiography. Third, to investigate the reliability of echocardiographic methods used to describe cardiac dysfunction in septic shock. Fourth, to study long-term cardiac outcome in severe sepsis and septic shock patients. Materials and methods: The cardiac biomarker amino-terminal pro-brain natriuretic peptide (NTproBNP) was collected in 481 patients on ICU admission and its ability to predict death was assessed. In 50 patients with septic shock, echocardiography was performed on ICU admission and was repeated during and after ICU stay. Measurements of cardiac strain using speckle tracking echocardiography were assessed in relation to other echocardiographic function parameters, NT-proBNP and severity of illness scores, and their change over time was analysed. Echocardiograms from patients with septic shock were independently evaluated by two physicians and the results analysed regarding measurement variability. A nationwide-registry-based open cohort of 9,520 severe sepsis and septic shock ICU patients discharged alive from the ICU was analysed together with a non-septic control group matched for age, sex and severity of illness. In patients who died after ICU discharge, information on causes of death was collected. Results: A discriminatory level of significance of NT-proBNP on ICU admission was identified at ≥1,380 ng/L, above which NT-proBNP was an independent predictor of death. With increasing levels of NT-proBNP, patients were more severely ill, had a longer ICU stay and were more often admitted with septic shock. Cardiac strain was frequently impaired in septic shock patients but was not superior to other echocardiographic measurements in detecting cardiac dysfunction. Cardiac strain correlated with other echocardiographic function parameters and with NT-proBNP, and was the least user-dependent echocardiographic parameter in septic shock patients. Cardiac strain remained unchanged over time, did not differ between survivors and non-survivors and could not predict an increased risk of death. During a follow-up of up to nearly 6 years after ICU discharge, 3,954 (42%) of sepsis patients died, 654 (17%) with cardiac failure as the cause of death. With increasing severity of illness on admission, the risk of death with cardiac failure as the cause of death after ICU discharge increased. In comparison to other ICU patients with similar severity of illness, however, the risk of death due to cardiac was not increased in patients with severe sepsis or septic shock. Conclusions: Laboratory or echocardiographic si...

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Outcome prediction in sepsis: Speckle tracking echocardiography based assessment of myocardial function

Cited by 154 publications

References 33 publications

Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

Cardiac Ultrasonography in the critical care setting: a practical approach to asses cardiac function and preload for the “non-cardiologist”

Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

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