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 Perioperative Medicine, Bart's Heart Centre St. Bartholomew's Hospital, W. Smithfield, London, UK.
Crit Care. 2018 Aug 4;22(1):183. doi: 10.1186/s13054-018-2113-y.
Sepsis-induced myocardial dysfunction is associated with poor outcomes, but traditional measurements of systolic function such as left ventricular ejection fraction (LVEF) do not directly correlate with prognosis. Global longitudinal strain (GLS) utilizing speckle-tracking echocardiography (STE) could be a better marker of intrinsic left ventricular (LV) function, reflecting myocardial deformation rather than displacement and volume changes. We sought to investigate the prognostic value of GLS in patients with sepsis and/or septic shock.
We conducted a systematic review (PubMed and Embase up to 26 October 2017) and meta-analysis to investigate the association between GLS and mortality at longest follow up in patients with severe sepsis and/or septic shock. In the primary analysis, we included studies reporting transthoracic echocardiography data on GLS according to mortality. A secondary analysis evaluated the association between LVEF and mortality including data from studies reporting GLS.
We included eight studies in the primary analysis with a total of 794 patients (survival 68%, n = 540). We found a significant association between worse LV function and GLS values and mortality: standard mean difference (SMD) - 0.26; 95% confidence interval (CI) - 0.47, - 0.04; p = 0.02 (low heterogeneity, I = 43%). No significant association was found between LVEF and mortality in the same population of patients (eight studies; SMD, 0.02; 95% CI - 0.14, 0.17; p = 0.83; no heterogeneity, I = 3%).
Worse GLS (less negative) values are associated with higher mortality in patients with severe sepsis or septic shock, while such association is not valid for LVEF. More critical care research is warranted to confirm the better ability of STE in demonstrating underlying intrinsic myocardial disease compared to LVEF.
脓毒症引起的心肌功能障碍与不良预后相关，但传统的收缩功能测量方法，如左心室射血分数（LVEF），并不能直接预测预后。利用斑点追踪超声心动图（STE）测量的整体纵向应变（GLS）可能是一种更好的左心室（LV）固有功能的标志物，它反映的是心肌变形，而不是位移和容积变化。我们旨在研究 GLS 在脓毒症和/或脓毒性休克患者中的预后价值。
我们进行了一项系统评价（PubMed 和 Embase 截至 2017 年 10 月 26 日）和荟萃分析，以调查在严重脓毒症和/或脓毒性休克患者中，最长随访时 GLS 与死亡率之间的相关性。在主要分析中，我们纳入了根据死亡率报告经胸超声心动图 GLS 数据的研究。二次分析评估了 GLS 和 LVEF 与死亡率之间的相关性，包括报告 GLS 数据的研究。
我们纳入了主要分析中的 8 项研究，共纳入 794 例患者（存活率为 68%，n=540）。我们发现，LV 功能越差，GLS 值越低，与死亡率的相关性越强：标准均数差（SMD）为-0.26；95%置信区间（CI）为-0.47，-0.04；p=0.02（低异质性，I=43%）。在同一患者人群中，我们没有发现 LVEF 与死亡率之间存在显著相关性（8 项研究；SMD，0.02；95%CI -0.14，0.17；p=0.83；无异质性，I=3%）。
在严重脓毒症或脓毒性休克患者中，GLS （负值越低）越差与死亡率越高相关，而 LVEF 则没有这种相关性。需要开展更多的重症监护研究，以证实 STE 比 LVEF 更能显示潜在的固有心肌疾病。
