Speckle-tracking echocardiography for detecting myocardial dysfunction in sepsis and septic shock patients: A single emergency department study

doi:10.5847/wjem.j.1920-8642.2022.057

Abstract

Abstract:

BACKGROUND: 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).

METHODS: 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.

RESULTS: 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 P>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 P<0.05). There were also moderate correlations between GLS and levels of cTnI (r=0.40, P=0.002) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) (r=0.44, P=0.001) in sepsis and septic shock patients.

CONCLUSION: 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.

Key words: Sepsis, Septic shock, Speckle-tracking echocardiography, Global longitudinal strain, Global circumferential strain

Xuan Fu, Xue Lin, Samuel Seery, Li-na Zhao, Hua-dong Zhu, Jun Xu, Xue-zhong Yu. Speckle-tracking echocardiography for detecting myocardial dysfunction in sepsis and septic shock patients: A single emergency department study[J]. World Journal of Emergency Medicine, 2022, 13(3): 175-181.

Figures/Tables 2

Table 1.

Two-dimensional echocardiographic parameters and laboratory tests of the investigated groups

Variables	Sepsis 3.0			cTnI (99^th URL) 0.056 μg/L			LVEF_SB
Variables	Septic shock (n=21)	Sepsis (n=39)	P	≥99^th URL (n=23)	<99^th URL (n=37)	P	<50% (n=14)	≥50% (n=46)	P
Conventional echocardiography
LVEF_Teich, %	61.45±11.55	62.53±7.43	0.70	58.97±9.45	64.09±8.28	0.03^*	54.49±9.50	64.45±7.55	0.01^*
LVEF_SB, %	53.42±6.96	55.04±6.19	0.36	51.71±7.59	56.17±5.06	0.01^*	45.79±3.82	57.10±4.49	0.01^*
CI, %	29.88±16.59	28.81±12.76	0.77	28.39±14.46	29.68±14.09	0.73	0.27±0.16	0.30±0.13	0.49
LVOT_VTI, mm	16.52±3.94	17.22±3.59	0.50	15.74±3.80	17.74±3.46	0.04^*	14.63±3.72	17.69±3.41	0.01^*
LVOT_SV, mL	39.34±11.69	44.51±10.26	0.08	38.87±11.05	45.08±10.34	0.03^*	40.38±13.50	43.40±10.13	0.37
LVOT_CO, L/min	3.83±1.42	3.85±1.24	0.93	3.83±1.49	3.78±1.15	0.92	3.74±1.40	3.82±1.26	0.83
E/A	1.01±0.26	1.07±0.35	0.33	1 (0.90, 1.18)	1 (0.94, 1.17)	0.58	1 (1.00, 1.55)	1 (0.91, 1.14)	0.26
e', cm/s	12.48±3.84	12.12±3.04	0.69	12.23±3.51	12.23±3.20	0.95	12.55±4.20	12.13±3.01	0.68
E/e' ratio (lateral)	6.33±2.19	6.02±2.07	0.59	6.13±2.42	6.07±1.88	0.77	5.89±2.32	6.16±2.03	0.68
Speckle-tracking echocardiography
GLS, %	-15.48±3.43	-16.59±3.82	0.27	-14.74±4.21	-17.11±3.06	0.02^*	-12.29±2.61	-17.39±3.12	0.01^*
GCS, %	-17.19±4.77	-16.38±4.17	0.50	-15.17±4.31	-17.59±4.19	0.04^*	-14.14±4.00	-17.43±4.22	0.01^*
GRS, %	22.81±5.68	19.87±5.56	0.06	19.35±5.89	21.86±5.49	0.09	18.79±5.40	21.54±5.73	0.12
LVEF_STI, %	49.00±10.81	50.78±9.59	0.52	46.61±11.37	52.36±8.43	0.03^*	38.31±8.25	53.76±7.34	0.01^*
Laboratory test
Platelet, ×10⁹/L	186.05±96.42	178.85±100.07	0.79	149.61±88.79	201.11±99.47	0.05	132.00±86.25	196.39±97.30	0.03^*
CRP, mg/L	127.48±89.94	152.93±81.46	0.64	150.67±82.50	160.19±80.60	0.66	171.75±87.04	151.91±79.18	0.43
Procalcitonin, ng/L	4.65 (0.58, 16.50)	6.00 (1.00, 16.00)	0.17	10.00 (2.90, 74.00)	5.30 (1.40, 18.00)	0.04^*	10.00 (5.25, 91.00)	5.20 (1.30, 17.00)	0.14
cTnI, ng/mL	0.03 (0, 0.68)	0.02 (0, 0.02)	0.23	0 (0, 3.00)	0.02 (0, 0.02)	0.01^*	0.02 (0, 3.25)	0.02 (0, 0.02)	0.16
NT-proBNP, ng/mL	2989 (1002, 9663)	1031 (165, 5423)	0.02^*	6436 (2763, 17254)	881 (200, 1596)	0.01^*	12026 (4929, 18810)	1028 (246, 2832)	0.01^*
CK, U/L	108 (68, 391)	72 (34, 271)	0.31	180 (74, 414)	63 (32, 136)	0.30	233 (61, 945)	75 (35, 248)	0.11
CK-MB, U/L	1.8 (0.8, 5.7)	1.0 (0, 2.0)	0.05	2.0 (1.0, 9.0)	1.0 (0, 2.0)	0.10	2.0 (1.0, 18.0)	1.0 (0, 2.1)	0.02^*
Cr, μmol/L	156 (106, 224)	87 (59, 139)	0.01^*	136 (94, 209)	95 (58, 150)	0.05	159 (82, 232)	103 (63, 146)	0.09
Lac, mmol/L	3.3 (2.2,5.4)	2.0 (1.0, 2.0)	0.01^*	2.0 (2.0, 4.0)	2.0 (1.0, 3.0)	0.29	2.5 (2.0, 5.3)	2.0 (1.0, 3.0)	0.09

Table 1.

Figure 1.

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