Patel Meghna D, Mariano Karley, Dunbar Trevor, Cornell Timothy T, Punn Rajesh, Haileselassie Bereketeab
Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
Pediatr Crit Care Med. 2020 Apr;21(4):e192-e199. doi: 10.1097/PCC.0000000000002247.
Sepsis-induced myocardial dysfunction has been associated with illness severity and mortality in pediatrics. Although early sepsis-induced myocardial dysfunction diagnosis could aid in hemodynamic management, current echocardiographic metrics for assessing biventricular function are limited in detecting early impairment. Strain echocardiography is a validated quantitative measure that can detect subtle perturbations in left ventricular and right ventricular function. This investigation evaluates the utility of strain echocardiography in pediatric sepsis and compares with to conventional methods.
Retrospective, observational study comparing left ventricular and right ventricular strain. Strain was compared with ejection fraction and fractional shortening and established sepsis severity of illness markers.
Tertiary care medical-surgical PICU from July 2013 to January 2018.
Seventy-nine septic children and 28 healthy controls.
None.
Compared with healthy controls, patients with severe sepsis demonstrated abnormal left ventricular strain (left ventricular longitudinal strain: -13.0% ± 0.72; p = 0.04 and left ventricular circumferential strain: -16.5% ± 0.99; p = 0.046) and right ventricular (right ventricular longitudinal strain = -14.3% ± 6.3; p < 0.01) despite normal fractional shortening (36.0% ± 1.6 vs 38.1% ± 1.1; p = 0.5129) and ejection fraction (60.7% ± 2.2 vs 65.3% ± 1.5; p = 0.33). There was significant association between depressed left ventricular longitudinal strain and increased Vasotrope-Inotrope Score (r = 0.52; p = 0.034). Worsening left ventricular circumferential strain was correlated with higher lactate (r = 0.31; p = 0.03) and higher Pediatric Risk of Mortality-III score (r = 0.39; p < 0.01). Depressed right ventricular longitudinal strain was associated with elevated pediatric multiple organ dysfunction score (r = 0.44; p < 0.01) CONCLUSIONS:: Compared with healthy children, pediatric septic patients demonstrated abnormal left ventricular and right ventricular strain concerning for early signs of cardiac dysfunction. This was despite having normal ejection fraction and fractional shortening. Abnormal strain was associated with abnormal severity of illness markers. Strain echocardiography may have utility as an early indicator of sepsis-induced myocardial dysfunction in pediatric sepsis.
脓毒症诱发的心肌功能障碍与儿科疾病的严重程度和死亡率相关。尽管早期诊断脓毒症诱发的心肌功能障碍有助于血流动力学管理，但目前用于评估双心室功能的超声心动图指标在检测早期损伤方面存在局限性。应变超声心动图是一种经过验证的定量测量方法，可检测左心室和右心室功能的细微扰动。本研究评估应变超声心动图在儿科脓毒症中的应用，并与传统方法进行比较。
一项比较左心室和右心室应变的回顾性观察性研究。将应变与射血分数、缩短分数以及既定的脓毒症疾病严重程度标志物进行比较。
2013年7月至2018年1月的三级医疗外科重症监护病房。
79名脓毒症患儿和28名健康对照者。
无。
与健康对照者相比，严重脓毒症患者的左心室应变异常（左心室纵向应变：-13.0%±0.72；p = 0.04，左心室圆周应变：-16.5%±0.99；p = 0.046），右心室应变也异常（右心室纵向应变=-14.3%±6.3；p < 0.01），尽管缩短分数正常（36.0%±1.6 vs 38.1%±1.1；p = 0.5129）和射血分数正常（60.7%±2.2 vs 65.3%±1.5；p = 0.33）。左心室纵向应变降低与血管活性药物-正性肌力药物评分增加之间存在显著相关性（r = 0.52；p = 0.034）。左心室圆周应变恶化与较高的乳酸水平（r = 0.31；p = 0.03）和较高的儿科死亡风险-III评分（r = 0.39；p < 0.01）相关。右心室纵向应变降低与儿科多器官功能障碍评分升高相关（r = 0.44；p < 0.01）
与健康儿童相比，儿科脓毒症患者表现出左心室和右心室应变异常，提示存在心脏功能障碍的早期迹象。尽管射血分数和缩短分数正常，但仍出现这种情况。异常应变与疾病严重程度标志物异常相关。应变超声心动图可能作为儿科脓毒症中脓毒症诱发的心肌功能障碍的早期指标。
