Strain echocardiography in septic shock – a comparison with systolic and diastolic function parameters, cardiac biomarkers and outcome

Geer, Lina De; Engvall, Jan; Oscarsson, Anna

doi:10.1186/s13054-015-0857-1

Cited by 88 publications

(94 citation statements)

References 30 publications

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“…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]. These findings were confirmed in 35 patients with septic shock [22].…”

Section: Speckle-tracking In the Intensive Care Unitmentioning

confidence: 84%

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: Speckle-tracking In the Intensive Care Unitmentioning

confidence: 84%

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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“…Of the 46 studies included in this review, 35 examined the association of brain natriuretic peptides (BNP, NT‐proBNP) with survival in patients with septic shock, presented in Table . The vast majority were prospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

“…This association was also evaluated by two studies in the setting of an RCT evaluating the use of 20% human albumin plus crystalloids or crystalloids alone in patients with severe sepsis or septic shock . In total, 30 studies, including the two conducted in the setting of the RCT, have found a significant association between elevated levels of brain natriuretic peptides and increased mortality …”

Section: Resultsmentioning

confidence: 99%

“…In regard to the secondary outcome of assessing cardiac function, many studies report an association between the levels of brain natriuretic peptides and various indices of myocardial dysfunction . Septic shock appears to be a strong stimulus for the release of natriuretic peptides, and their levels have been used successfully to distinguish between septic and cardiogenic shock, as well as septic and other kinds of shock, although this was not confirmed by other researchers .…”

Section: Discussionmentioning

confidence: 99%

“…The primary outcome of this systematic review was to assess the utility of BNP and NT‐proBNP as prognostic markers in septic shock. Brain natriuretic peptides have been shown to be adequate predictors of mortality in septic shock by numerous studies . However, there are significant differences in the reported limits for an optimal cut‐off value, ranging from 210 to 800 ng/L for BNP, with suboptimal sensitivity and specificity .…”

Section: Discussionmentioning

confidence: 99%

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The utility of brain natriuretic peptides in septic shock as markers for mortality and cardiac dysfunction: A systematic review

et al. 2019

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Objective To conduct a systematic review evaluating the utility of brain natriuretic peptide (BNP) and N‐terminal proBNP (NT‐proBNP) as biomarkers in adult patients with septic shock. Materials and Methods Pubmed/Medline databases were searched from inception to November 2018 using the search terms: (septic[Title/Abstract] AND shock[Title/Abstract]) AND bnp[Title/Abstract]) and (septic[Title/Abstract]) AND shock[Title/Abstract]) AND natriuretic[Title/Abstract]). No restriction was applied regarding date of publication. Comparative observational studies evaluating BNP and NT‐proBNP in patients with septic shock aged ≥18 years were eligible for inclusion. Bibliographies from the extracted articles were also reviewed to identify additional relevant publications. Results In total, 46 studies met all eligibility criteria and were included. A strong body of literature has demonstrated that in patients with septic shock, increased values of BNP and NT‐proBNP are associated with increased mortality. An increase from baseline BNP values has also been associated with increased mortality, whereas decreases from baseline values are not related to worse outcome. Brain natriuretic peptides have also been associated with cardiac dysfunction in patients with sepsis. Moreover, BNP values have been found to be significantly elevated in septic shock, regardless of cardiac dysfunction, and have been used to distinguish between septic and cardiogenic shock. Furthermore, BNP and NT‐proBNP are significantly increased in patients with septic shock, compared to patients with sepsis and severe sepsis. Conclusions BNP and NT‐proBNP appear to be reliable predictors of outcome in septic shock.

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Cardiovascular Responses During Sepsis

Pecchiari

Pontikis

Alevrakis

et al. 2021

Comprehensive Physiology

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Sepsis is the life-threatening organ dysfunction arising from a dysregulated host response to infection.Although the specific mechanisms leading to organ dysfunction are still debated, impaired tissue oxygenation appears to play a major role, and concomitant hemodynamic alterations are invariably present. The hemodynamic phenotype of affected individuals is highly variable for reasons that have been partially elucidated. Indeed, each patient's circulatory condition is shaped by the complex interplay between the medical history, the volemic status, the interval from disease onset, the pathogen, the site of infection and the attempted resuscitation. Moreover, the same hemodynamic pattern can be generated by different combinations of various pathophysiological processes, so the presence of a given hemodynamic pattern cannot be directly related to a unique cluster of alterations. Research based on endotoxin administration to healthy volunteers and animal models compensate, to an extent, for the scarcity of clinical studies on the evolution of sepsis hemodynamics. Their results, however, cannot be directly extrapolated to the clinical setting, due to fundamental differences between the septic patient, the healthy volunteer and the experimental model. Numerous microcirculatory derangements might exist in the septic host, even in the presence of a preserved macrocirculation. This dissociation between the macro-and the micro-circulation might account for the limited success of therapeutic interventions targeting typical hemodynamic parameters, such as arterial and cardiac filling pressures, and cardiac output. Finally, physiological studies point to an early contribution of cardiac dysfunction to the septic phenotype, however our defective diagnostic tools preclude its clinical recognition.) to anesthetized, vagotomized and mechanically ventilated Sprague-Dawley rats on the operating point of the baroreflex using a baroreflex diagram (SNA: sympathetic nervous activity; CSP: carotid sinus pressure; AP: arterial pressure). As time passes after lipopolysaccharide injection, the neural arc 9 progressively shifts rightwards, and the peripheral arc downwards, so the operating point moves from a (baseline) to b at 1 hour and to c at 2 hours, showing a progressive increase of SNA with little change of AP. From (523), with permission under the terms of the Creative Commons Attribution License. significantly (from 1.7±0.5 to 1.4±0.2 mmHg ml -1 min) (313). In the same preparation N w -nitro-L-methyl ester (L-NAME) increases SVR more than R VR both in the presence (+294 and +129%, respectively) and in the absence (+196 and +107%, respectively) of fluid-loading. In another study from the same group, L-NAME elicited similar effects (117). Overall, these experimental studies warn against the assumption that changes of SVR are always paralleled by similar changes of R VR .

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Strain echocardiography in septic shock – a comparison with systolic and diastolic function parameters, cardiac biomarkers and outcome

Cited by 88 publications

References 30 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

The utility of brain natriuretic peptides in septic shock as markers for mortality and cardiac dysfunction: A systematic review

Cardiovascular Responses During Sepsis

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