de Braga Lima Carvalho Canesso Mariana, Borges Isabela Nascimento, de Deus Queiroz Santos Thiago Adriano, Ris Tijmen Hermen, de Barros Marcio Vinicius Lins, Nobre Vandack, Nunes Maria Carmo Pereira
Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130100, Brazil.
Hospital das Clinicas, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Int J Cardiovasc Imaging. 2019 May;35(5):855-859. doi: 10.1007/s10554-018-01525-1. Epub 2019 Mar 7.
Speckle-tracking echocardiography (STE) has been increasingly used for detection of sepsis-related myocardial dysfunction. However, the impact of strain changes during sepsis treatment has not been defined. This study assessed STE at admission and during the treatment of patients with sepsis to evaluate its changes as a potential factor for predicting in-hospital outcome. This study included 26 patients with sepsis who underwent STE echocardiography on day 1 and 7 during treatment. Myocardial deformation of both ventricles was assessed using global longitudinal strain. The endpoint was in-hospital mortality. The mean age was 51.4 ± 18.3 years, and 54% were female. The average SOFA score at T0 was 8.6 ± 3.8 points and at day 7 was 4.9 ± 4.7 points. The left ventricular (LV) ejection fraction at baseline was 65.6 ± 9.1%, without changes in echocardiographic parameters during treatment. LV and RV longitudinal strain increased significantly in the patients who survived (- 18.8 ± 3.6 at D1 vs - 20.8 ± 2.5 at D7; p = 0.003; and - 21.3 ± 4.9 at D1 vs - 24.3 ± 5.8 at D7; p = 0.035, respectively), whereas strain values remained unchanged in those who died. After adjustment for the SOFA score, RV longitudinal strain at admission was associated with in-hospital mortality [adjusted odds ratio (OR) 0.760; 95% confidence interval (CI) 0.591-0.977; p - 0.033]. STE improved significantly after the first week of treatment in patients with sepsis who survived compared with those patients who died during hospitalization. RV strain at admission predicted in-hospital mortality. An improvement in STE during sepsis treatment appears to be a useful tool for predicting in-hospital outcome.
斑点追踪超声心动图（STE）已越来越多地用于检测脓毒症相关的心肌功能障碍。然而，脓毒症治疗期间应变变化的影响尚未明确。本研究评估了脓毒症患者入院时及治疗期间的STE，以评估其变化作为预测住院结局的潜在因素。本研究纳入了26例脓毒症患者，这些患者在治疗第1天和第7天接受了STE超声心动图检查。使用整体纵向应变评估双心室的心肌变形。终点为住院死亡率。平均年龄为51.4±18.3岁，54%为女性。T0时平均序贯器官衰竭评估（SOFA）评分为8.6±3.8分，第7天时为4.9±4.7分。基线时左心室（LV）射血分数为65.6±9.1%，治疗期间超声心动图参数无变化。存活患者的左心室和右心室纵向应变显著增加（第1天为-18.8±3.6 vs第7天为-20.8±2.5；p = 0.003；第1天为-21.3±4.9 vs第7天为-24.3±5.8；p = 0.035），而死亡患者的应变值保持不变。在调整SOFA评分后，入院时右心室纵向应变与住院死亡率相关[调整后的比值比（OR）0.760；95%置信区间（CI）0.591 - 0.977；p = 0.033]。与住院期间死亡的患者相比，存活的脓毒症患者在治疗第一周后STE显著改善。入院时右心室应变可预测住院死亡率。脓毒症治疗期间STE的改善似乎是预测住院结局的有用工具。
