Author + information
- Stefanie Furlan,
- Elie Donath,
- Samineh Sehatbakhsh and
- Robert Chait
Background: Myocardial dysfunction may be induced in sepsis due to mitochondrial injury and cytokine up-regulation. Conventional methods of measuring ejection fraction (EF), may fail to recognize early sepsis-induced myocardial dysfunction. Evaluating global longitudinal strain (GLS) using 2-D speckle tracking echocardiography (2D-STE) is a novel way to identify subclinical left ventricular dysfunction. Our goal was to determine if survivors of severe sepsis or septic shock had a significant difference in ejection fraction and global longitudinal strain, compared to non-survivors.
Methods: We conducted a meta-analysis and searched MEDLINE, EMBASE, and Cochrane. Selected studies reported GLS and EF amongst survivors and non-survivors of severe sepsis or septic shock within a 30-day period. The two primary outcomes were pooled standardized mean difference (SMD) of EF and GLS amongst survivors and non-survivors.
Results: Our search strategy identified four studies that met the inclusion criteria, and included 336 patients (228 survivors, 108 non-survivors) with severe sepsis or septic shock. The mean age, EF, and GLS of survivors was 67 years old, 55.5%, and −14.2%, respectively. While the mean age, EF, and GLS of non-survivors was 71.7 years old, 54.8%, and −12.8%, respectively. Our analysis revealed no significant standardized mean difference in ejection fraction amongst survivors versus non-survivors (EF pooled SMD=0.098; 95% CI:(-0.133, 0.329); p=0.406). However, survivors of severe sepsis/septic shock had a more negative GLS (more normal) when compared to non-survivors (GLS pooled SMD=0.434; 95% CI:(0.201, 0.667); p<0.01).
Conclusions: Despite having a preserved EF, non-survivors of severe sepsis/septic shock were noted to have a more positive GLS, indicating a greater degree of left ventricular dysfunction. Therefore, global longitudinal strain may be a sensitive marker in detecting sepsis-induced myocardial dysfunction and predicting survival in critically ill patients.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Innovative Use of Echocardiography
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1197-211
- 2017 American College of Cardiology Foundation