Department of Anaesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Via Tricomi 5, 90127 Palermo, Italy.
Department of Cardiovascular Anaesthesiology and Critical Care, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
Br J Anaesth. 2017 Oct 1;119(4):583-594. doi: 10.1093/bja/aex254.
Myocardial dysfunction may contribute to circulatory failure in sepsis. There is growing evidence of an association between left ventricular diastolic dysfunction (LVDD) and mortality in septic patients. Utilizing echocardiography, we know that tissue Doppler imaging (TDI) variables e' and E/e' are reliable predictors of LVDD and are useful measurements to estimate left ventricular (LV) filling pressures.
We conducted a systematic review and meta-analysis to investigate the association of e' and E/e' with mortality of patients with severe sepsis or septic shock. In the primary analysis, we included studies providing transthoracic TDI data for e' and E/e' and their association with mortality. Subgroup analyses were conducted according to myocardial regional focus of TDI assessment (septal, lateral or averaged). Three secondary analyses were performed: one included data from a transoesophageal study, another excluded studies reporting data at a very early (<6 h) or late (>48 h) stage following diagnosis, and the third pooled data only from studies excluding patients with heart valve disease.
The primary analysis included 16 studies with 1507 patients with severe sepsis and/or septic shock. A significant association was found between mortality and both lower e' [standard mean difference (SMD) 0.33; 95% confidence interval (CI): 0.05, 0.62; P=0.02] and higher E/e' (SMD -0.33; 95% CI: -0.57, -0.10; P=0.006). In the subgroup analyses, only the lateral TDI values showed significant association with mortality (lower e' SMD 0.45; 95% CI: 0.11, 0.78; P=0.009; higher E/e' SMD -0.49; 95% CI: -0.76, -0.22; P=0.0003). The findings of the primary analysis were confirmed by all secondary analyses.
There is a strong association between both lower e' and higher E/e' and mortality in septic patients.
心肌功能障碍可能导致脓毒症患者循环衰竭。越来越多的证据表明，左心室舒张功能障碍（LVDD）与脓毒症患者的死亡率之间存在关联。利用超声心动图，我们知道组织多普勒成像（TDI）变量 e' 和 E/e' 是 LVDD 的可靠预测指标，也是评估左心室（LV）充盈压的有用测量指标。
我们进行了系统评价和荟萃分析，以调查 e' 和 E/e' 与严重脓毒症或脓毒性休克患者死亡率的关系。在主要分析中，我们纳入了提供经胸 TDI 数据的研究，用于评估 e' 和 E/e' 及其与死亡率的关系。根据 TDI 评估的心肌区域焦点（间隔、侧壁或平均）进行亚组分析。进行了三次次要分析：一次包括经食管研究的数据，另一次排除了报告诊断后非常早期（<6 小时）或晚期（>48 小时）阶段数据的研究，第三次仅汇总排除了心脏瓣膜病患者的研究数据。
主要分析纳入了 16 项研究，共 1507 例严重脓毒症和/或脓毒性休克患者。死亡率与 e' 降低[标准均数差（SMD）0.33；95%置信区间（CI）：0.05，0.62；P=0.02]和 E/e' 升高[SMD -0.33；95% CI：-0.57，-0.10；P=0.006]均存在显著相关性。在亚组分析中，只有侧壁 TDI 值与死亡率存在显著相关性（e' 降低 SMD 0.45；95% CI：0.11，0.78；P=0.009；E/e' 升高 SMD -0.49；95% CI：-0.76，-0.22；P=0.0003）。所有次要分析均证实了主要分析的结果。
脓毒症患者的 e' 降低和 E/e' 升高与死亡率之间存在很强的关联。
