Global longitudinal strain to early detect myocardial dysfunction in septic shock: a systematic review

INTRODUCTION: Sepsis-induced myocardial dysfunction (SIMD) is a common and reversible complication of septic shock that is often underdiagnosed due to the limitations of conventional echocardiography. Global longitudinal strain (GLS) derived from speckle tracking echocardiography (STE) may provide a more sensitive and load-independent marker of early myocardial dysfunction. The aim of this study was to assess the diagnostic and prognostic value of GLS in patients with septic shock in the ICU. EVIDENCE ACQUISITION: This systematic review followed the PRISMA guideline and published on PROSPERO (CRD420251034407). Four databases (PubMed, Scopus, Web of Science and Cochrane) were searched without time or language restrictions (Sept-Oct 2024). Eligible studies included adults with sepsis or septic shock studied with GLS. Risk of bias was assessed using the Newcastle-Ottawa Scale. EVIDENCE SYNTHESIS: Of 24 studies, five studies were included (416 patients). GLS was significantly reduced in patients with septic shock, even with preserved LVEF. A GLS threshold between -13% and -15% predicted mortality and correlated with biomarkers (troponin I, NT-proBNP, lactate). Compared to LVEF, GLS showed higher sensitivity in detecting subclinical dysfunction and in monitoring myocardial recovery. GLS in a single view (apical four-chamber) was comparable to full-view assessment, suggesting feasibility at the bedside. CONCLUSIONS: Despite the limited number and observational nature of the available studies, GLS appears to be a promising tool for the early detection and monitoring of myocardial dysfunction in septic shock. Its integration into ICU practice could improve risk stratification and individualized treatment. Further multicenter studies are needed to standardize the cut-offs and confirm the clinical benefit.