Fu Xuan, Lin Xue, Seery Samuel, Zhao Li-Na, Zhu Hua-Dong, Xu Jun, Yu Xue-Zhong
Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
World J Emerg Med. 2022;13(3):175-181. doi: 10.5847/wjem.j.1920-8642.2022.057.
Septic cardiomyopathy (SCM) occurs in the early stage of sepsis and septic shock, which has implications for treatment strategies and prognosis. Additionally, myocardial involvement in the early stages of sepsis is difficult to identify. Here, we assess subclinical myocardial function using laboratory tests and speckle-tracking echocardiography (STE).
Emergency department patients diagnosed with sepsis or septic shock were included for analysis. Those with other causes of acute or pre-existing cardiac dysfunction were excluded. Transthoracic echocardiography (TTE), including conventional echocardiography and STE, were performed for all patients three hours after initial resuscitation. Samples for laboratory tests were taken around the time of TTE.
Left ventricular functions of 60 patients were analyzed, including 21 septic shock patients and 39 sepsis patients. There was no significant difference in global longitudinal strain (GLS), global circumferential strain (GCS), or global radical strain (GRS) between patients with sepsis and septic shock (all with >0.05). However, GLS and GCS were significantly less negative in patients with abnormal troponin levels or in patients with abnormal left ventricular ejection fraction (LVEF) values (all with <0.05). There were also moderate correlations between GLS and levels of cTnI (=0.40, =0.002) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) (=0.44, =0.001) in sepsis and septic shock patients.
Myocardial dysfunction, e.g., lower LVEF or less negative GLS in patients with sepsis or septic shock, is more affected by myocardial injury. GLS could be incorporated into mainstream clinical practice as a supplementary LVEF parameter, especially for those with elevated troponin levels.
脓毒症性心肌病（SCM）发生于脓毒症和脓毒性休克的早期，这对治疗策略和预后具有重要意义。此外，脓毒症早期的心肌受累情况难以识别。在此，我们使用实验室检查和斑点追踪超声心动图（STE）评估亚临床心肌功能。
纳入急诊科诊断为脓毒症或脓毒性休克的患者进行分析。排除其他急性或既往存在的心脏功能障碍原因的患者。所有患者在初始复苏3小时后进行经胸超声心动图（TTE）检查，包括传统超声心动图和STE。在TTE检查时采集实验室检查样本。
分析了60例患者的左心室功能，其中包括21例脓毒性休克患者和39例脓毒症患者。脓毒症患者和脓毒性休克患者之间的整体纵向应变（GLS）、整体圆周应变（GCS）或整体径向应变（GRS）无显著差异（均P>0.05）。然而，肌钙蛋白水平异常的患者或左心室射血分数（LVEF）值异常的患者的GLS和GCS显著降低（均P<0.05）。脓毒症和脓毒性休克患者的GLS与心肌肌钙蛋白I（cTnI）水平（r=0.40，P=0.002）或N末端B型利钠肽原（NT-proBNP）水平（r=0.44，P=0.001）也存在中度相关性。
脓毒症或脓毒性休克患者的心肌功能障碍，如较低的LVEF或较低负值的GLS，受心肌损伤的影响更大。GLS可作为补充LVEF的参数纳入主流临床实践，尤其是对于肌钙蛋白水平升高的患者。
