Prognostic value and time course evolution left ventricular global longitudinal strain in septic shock: an exploratory p
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ORIGINAL RESEARCH
Prognostic value and time course evolution left ventricular global longitudinal strain in septic shock: an exploratory prospective study Florian Bazalgette1,2 · Claire Roger1,2 · Benjamin Louart1,2 · Aurélien Daurat1 · Xavier Bobbia1,2 · Jean‑Yves Lefrant1,2 · Laurent Muller1,2 Received: 17 April 2020 / Accepted: 13 November 2020 © Springer Nature B.V. 2020
Abstract Our main objective was to describe the course of GLS during the first days of septic shock and to assess the agreement between GLS values and longitudinal strain measured in apical four chambers. A prospective observational single centre study was conducted at the Nimes University Hospital’s ICU. All patients admitted for a diagnosis of septic shock without pre-existing heart disease were eligible. Echocardiography (LVEF and GLS) was performed on the first day, and repeated once between day 3 and day 5 then once between day 6 and day 8. We enrolled 40 consecutive patients. Four patients were excluded. In overall population, GLS at T1 was impaired (− 11.0%, IQR(interquartile range) [− 15; − 10]). On T2 exams, a significant improvement of the GLS (− 11% vs − 16% p = 0.02) was observed whereas LVEF remained stable over time. A good agreement between GLS and longitudinal strain measured on a four chambers view was found. Based on the Bland and Altman method, the mean of differences for T1 exams was 0.1 (95% CI [− 0.6; 0.8]) with limits of agreement ranging from − 4 to 4. Myocardial strain is depressed at the early phase of septic shock and improves over time. A single measurement of LS4C view appears sufficient at bedside. Keywords Speckle-tracking · Strain · Septic cardiomyopathy · Echocardiography · Systolic · Septic shock
1 Introduction Septic cardiomyopathy (SCM) is observed in up to 40% of patients with septic shock [1]. This clinical entity has been firstly described by Parker in the 80’s, who suggested that left ventricle ejection fraction (LVEF) was paradoxically higher in non-survivors of septic shock [2]. Subsequent studies did not confirm these results and a meta-analysis did not show any link between LVEF and mortality in septic population [3]. Several reviews discuss the pathogenesis of cardiac impairment in sepsis. Although no improvement in patient prognosis has been shown, ultrasound remains the more suitable tool for the evaluation of SCM [4].
* Florian Bazalgette florian.bazalgette@chu‑nimes.fr 1
Department of Anaesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Place du Professeur Robert Debré, 30 029 cedex 9 Nîmes, France
Laboratory of Physiology, EA 2992, Faculty of Medicine, Montpellier-Nimes University, Nîmes, France
2
The main mechanism for high LVEF is a profound inflammatory-induced vasoplegia, which decreases cardiac afterload and artificially increases LVEF. Severe vasoplegia and high dose of vasopressors requirement is associated with poor outcome, leading to refractory shock [5]. Thus, LVEF was considered as too dependent on loading conditions to be a reliab
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