Speckle tracking echocardiography in patients with septic shock: a case control study (SPECKSS)

• Published in: Critical care (London, England) England), 2016-05, Vol.20 (1), p.145-145, Article 145
• Main Authors: Ng, Pauline Yeung, Sin, Wai Ching, Ng, Andrew Kei-Yan, Chan, Wai Ming
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cardiac Output - physiology; Care and treatment; Case-Control Studies; Echocardiography; Echocardiography - methods; Elasticity Imaging Techniques - methods; Female; Heart Failure - etiology; Heart Failure - physiopathology; Humans; Intensive Care Units; Male; Middle Aged; Risk Factors; Septic shock; Services; Shock, Septic - radiotherapy
• ISSN: 1364-8535; 1466-609X; 1364-8535
• DOI: 10.1186/s13054-016-1327-0

Sepsis-induced myocardial dysfunction is a well-recognized condition and confers worse outcomes in septic patients. Echocardiographic assessment by conventional parameters such as left ventricular ejection fraction (LVEF) is often affected by ongoing changes in preload and afterload conditions. Novel echocardiographic technologies such as speckle tracking echocardiography (STE) have evolved for direct assessment of the myocardial function. We investigate the measurement of myocardial strain by speckle tracking echocardiography for the diagnosis of sepsis-induced myocardial dysfunction. This is a case-control study at a university-affiliated medical intensive care unit. Consecutive adult medical patients admitted with a diagnosis of septic shock were included. Patients with other causes of myocardial dysfunction were excluded. They were compared to age-matched, gender-matched, and cardiovascular risk-factor-matched controls, who were admitted to hospital for sepsis but did not develop septic shock. Transthoracic echocardiography was performed on all patients within 24 hours of diagnosis, and a reassessment echocardiogram was performed in the study group of patients upon recovery. Patients with septic shock (n = 33) (study group) and 29 matched patients with sepsis but no septic shock (control group) were recruited. The mean sequential organ failure assessment (SOFA) score for the study and control groups were 10.2 and 1.6, respectively (P < 0.001). In patients with septic shock, the mean arterial pressure was lower (76 mmHg vs 82 mmHg, P = 0.032), and the heart rate was higher (99 bpm vs 86 bpm, P = 0.008). The cardiac output (5.9 L/min vs 5.5 L/min, P = 0.401) and systemic vascular resistance (1090 dynes•sec/cm(5) vs 1194 dynes•sec/cm(5), P = 0.303) were similar. The study group had a greater degree of myocardial dysfunction measured by global longitudinal strain (GLS) (-14.5 % vs -18.3 %, P