Severe sepsis was associated with significantly impaired left ventricular global systolic strain (-14.9% vs -17.3%) compared to non-septic trauma patients with preserved ejection fraction.
Observational (n=88)
Single-blind
No
Does early severe sepsis or septic shock cause impaired longitudinal systolic function detectable by strain echocardiography in patients with preserved ejection fraction?
Absolute Event Rate: -14.9% vs -17.3%
p-value: p=0.014
BACKGROUND: Myocardial dysfunction is recognized in sepsis. We hypothesized that mechanical left (LV) and right (RV) ventricular function analysed using 2-dimensional speckle-tracking echocardiography in a cohort of early severe sepsis or septic shock patients, would be different to that of a group of critically ill, non-septic patients. METHODS: Critically ill adult patients with early, severe sepsis/septic shock (n = 48) and major trauma patients with no sepsis (n = 24) were included retrospectively, as well as healthy controls (n = 16). Standard echocardiographic examinations, including right (RV) left (LV) volumes and mitral, aortic and pulmonary vein Doppler flow profiles, were retrospectively identified and the studies were then reanalysed for assessment of myocardial strain using speckle-tracking echocardiography. Endocardial tracing of the LV was performed in apical four-chamber (4-Ch), two-chamber (2-Ch), apical long-axis (3-Ch) and apical views of RV determining the longitudinal LV and RV free wall strain in each subject. RESULTS: In septic patients, heart rate was significantly higher (p = 0.009) and systolic (p 50%, n = 34), seventeen patients (50%) had a depressed LV global longitudinal function, defined as a LV global strain > -15%, compared to two patients (8.7%) in the non-septic group (p = 0.0014). In septic patients with preserved LVEF, LV global and RV free wall strain were 14% (p = 0.014) and 17% lower (p = 0.008), respectively, compared to the non-septic group with preserved LVEF. There were no significant differences between groups with respect to LV end-diastolic or end-systolic volumes, stroke volume, or cardiac output. There were no signs of diastolic dysfunction from the mitral or pulmonary vein Doppler profiles in the septic patients. CONCLUSIONS: LV and RV systolic function is impaired in critically ill patients with early septic shock and preserved LVEF, as detected by Speckle-tracking 2D echocardiography. Strain imaging may be useful in the early detection of myocardial dysfunction in sepsis.
Dalla et al. (Wed,) conducted a observational in Severe sepsis or septic shock (n=88). Severe sepsis or septic shock vs. Major trauma without sepsis was evaluated on Left ventricular global systolic strain in patients with preserved ejection fraction (p=0.014). Severe sepsis was associated with significantly impaired left ventricular global systolic strain (-14.9% vs -17.3%) compared to non-septic trauma patients with preserved ejection fraction.
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