Cinotti Raphaël, Delater Adrien, Fortuit Camille, Roquilly Antoine, Mahé Pierre-Joachim, Demeure-dit-Latte Dominique, Asehnoune Karim
Department of Anesthesiology and Critical Care Medicine, CHU de Nantes, France.
Anaesthesiol Intensive Ther. 2015;47(5):482-6. doi: 10.5603/AIT.a2015.0078. Epub 2015 Nov 20.
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.
斑点追踪分析是心脏病学中一种用于评估左心室功能的新型可用工具。其新颖之处在于具备在心动周期中追踪心肌内天然声学标记（即斑点）的技术能力。这项技术能够评估心肌在收缩期和舒张期的应变。迄今为止，整体纵向应变（GLS）在心脏病学领域已得到广泛研究。现已明确，在检测收缩功能损害方面，GLS比二维超声心动图测量的左心室射血分数更敏感。在预测主要心血管事件方面，它也优于左心室射血分数。在重症监护病房（ICU）环境中，相关数据较少。在脓毒性休克的实验模型和人体研究中，斑点追踪分析表明，在左心室射血分数保持正常的情况下，GLS会受损。近期数据还表明，GLS受损可预测脓毒性休克患者在ICU内的死亡率。在严重蛛网膜下腔出血患者中，斑点追踪分析在检测应激性心肌病方面可能更敏感。然而，在危重症患者中仍有许多空白有待填补。例如，机械通气对GLS的影响尚未完全阐明，而且迄今为止，用于准确评估GLS改变对患者预后潜在影响的数据过少。尽管如此，这种新工具能提供客观且敏感的数据，观察者内和观察者间的变异性均可接受，在评估ICU患者左心室收缩功能方面可能具有重要价值。
