Hai Pham Dang, Phuong Le Lan, Dung Nguyen Manh, Hoa Le Thi Viet, Quyen Do Van, Chinh Nguyen Xuan, Minh Vu Duy, Nguyen Son Pham
Intensive Care Unit, 108 Military Central Hospital, Ha Noi, Vietnam.
Intensive Care Unit, Tam Anh General Hospital, Ha Noi, Vietnam.
Crit Care Res Pract. 2020 Sep 21;2020:6098654. doi: 10.1155/2020/6098654. eCollection 2020.
Left ventricular dysfunction is quite common in septic shock. Speckle-tracking echocardiography (STE) is a novel, highly sensitive method for assessing left ventricular function, capable of detecting subclinical myocardial dysfunction, which is not identified with conventional echocardiography. We sought to evaluate subclinical left ventricular systolic function in patients with septic shock using speckle-tracking echocardiography.
From May 2017 to December 2018, patients aged ≥18 years admitted to the intensive care unit with the diagnosis of sepsis and septic shock based on the sepsis-3 definition were included. Patients with other causes of cardiac dysfunction were excluded. Transthoracic echocardiography was performed for all the patients within 24 hours of diagnosis. Left ventricular systolic function was assessed using conventional echocardiography and speckle-tracking echocardiography.
Patients with septic shock ( = 90) (study group) and 37 matched patients with sepsis but no septic shock (control group) were included. Left ventricular ejection fraction (LVEF) by conventional echocardiography showed no significant difference between two groups (58.2 ± 9.9 vs. 58.6 ± 8.3, =0.804). The global longitudinal strain (GLS) by STE was significantly reduced in patients with septic shock compared with that in the control (-14.6 ± 3.3 vs. -17.1 ± 3.3, < 0.001). Based on the cutoff value of GLS ≥ -15% for the definition of subclinical left ventricular systolic dysfunction, this dysfunction was detected in 50 patients with septic shock (55.6%) and in 6 patients in the control group (16.2%) ( < 0.05).
Speckle-tracking echocardiography can detect early subclinical left ventricular systolic dysfunction via the left ventricular global longitudinal strain compared with conventional echocardiographic parameters in patients with septic shock.
左心室功能障碍在感染性休克中相当常见。斑点追踪超声心动图（STE）是一种用于评估左心室功能的新型、高灵敏度方法，能够检测出传统超声心动图无法识别的亚临床心肌功能障碍。我们试图使用斑点追踪超声心动图评估感染性休克患者的亚临床左心室收缩功能。
纳入2017年5月至2018年12月期间因脓毒症和感染性休克诊断入住重症监护病房且年龄≥18岁的患者，这些诊断基于脓毒症-3定义。排除其他原因导致心脏功能障碍的患者。在诊断后24小时内对所有患者进行经胸超声心动图检查。使用传统超声心动图和斑点追踪超声心动图评估左心室收缩功能。
纳入感染性休克患者（n = 90）（研究组）和37例匹配的脓毒症但无感染性休克患者（对照组）。传统超声心动图测得的左心室射血分数（LVEF）在两组间无显著差异（58.2±9.9 vs. 58.6±8.3，P = 0.804）。与对照组相比，感染性休克患者经STE测得的整体纵向应变（GLS）显著降低（-14.6±3.3 vs. -17.1±3.3，P < 0.001）。基于GLS≥-15%作为亚临床左心室收缩功能障碍定义的临界值，50例感染性休克患者（55.6%）和6例对照组患者（16.2%）检测到该功能障碍（P < 0.05）。
与传统超声心动图参数相比，斑点追踪超声心动图可通过左心室整体纵向应变检测感染性休克患者早期亚临床左心室收缩功能障碍。
