Key result
3D and 2D LVGLS strongly correlate in quickly detecting covert septic myocardial dysfunction.
Why the study?
The nature and clinical features of left ventricular myocardial deformation in sepsis or septic shock are unclear, and consensus on ideal treatment is lacking.
Observational (n=103)
No
Effect estimate: r=0.772
p-value: p=0.0001
Serial 3D and 2D echocardiography demonstrates that LVGLS can detect covert septic myocardial dysfunction in ICU patients when LVEF appears normal.
May aid detection of septic myocardial dysfunction despite normal LVEF; hypothesis-generating and requires prospective validation.
BackgroundLeft ventricular myocardial deformation develops dynamically when circulatory system is disturbed. What is less clear are the nature and clinical fetures of the deformation., and a consensus is yet to be reached for an ideal treatment plan. This study aims to explore the development of left ventricular myocardial deformation in septic patients by observing the serial changes in three- and two-dimensional strain parameters.Methods In this single-centered, prospective, and observational study, we eventually included 103 patients diagnosed with sepsis or septic shock at the intensive care unit (ICU) from December 2020 until December 2021. Demographic data, medicine, laboratory and ultrasound values were collected and measured on the 1st, 2nd, 3rd, 5th, 7th and 10th days after sepsis or septic shock. A total of 88 adult patients for 2D-STE and 3D-STE were divided into two groups according to their wall motion status: the non-hypokinetics group and the secondary hypokinesia group. Results Patients underwent both 3D and 2D echocardiography to evaluate left ventricular function. Comparison of four time points between the two groups showed that 2D-LVEF demonstrated a progressive, stepwise improvement each time point assessed (Ptime=0.033, Pgroup=0.041, respectively). Although 3D-LVEF slightly underestimated the LV volumes at each time point, it displayed a same changing tendency during the 10 days (Ptime=0.002, Pgroup=0.011, respectively). Then, we used both 3D and 2D STE to observe left ventricular myocardial function and validated the applicability and feasibility of 3D-STE: 2D-LVGLS Ptime=0.000, Pgroup=0.018, respectively, 2D-LVGCS Ptime=0.000, Pgroup=0.332 respectively; 3D-LVGLS Ptime=0.000, Pgroup=0.391, respectively, 3D-LVGCS Ptime=0.022, Pgroup=0.362 respectively. The level of strain first decreased and then increased in these two groups during hospitalization, but both 3D and 2D strain imaged at the 10th day assessed were lower compared to that of normal healthy people. Moreover, 3D-LVGLS had a stronger correlation with 2D- LVGLS (r=0.772, P＜0.0001).ConclusionPatients with sepsis or septic shock demonstrated improvement of LV myocardial function during hospitalization, but their myocardial function was not fully recovered to normal on the 10th day. Both 3D and 2D LVGLS could quickly detect changes of patients with covert septic myocardial dysfunction, whereas LVEF could not.
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Xie et al. (2022) conducted an observational in Sepsis or septic shock (n=103). Sepsis or septic shock vs. Non-hypokinetics group was evaluated on Correlation between 3D-LVGLS and 2D-LVGLS (r=0.772, p=0.0001). In patients with sepsis or septic shock, both 3D and 2D global longitudinal strain quickly detected covert septic myocardial dysfunction, with 3D-LVGLS strongly correlating with 2D-LVGLS (r=0.772).
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