Myocardial strain is regulated by cardiac preload in the early stage of sepsis.
Cardiac preload
Echocardiography
Sepsis
Strain
Journal
BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539
Informations de publication
Date de publication:
14 Aug 2024
14 Aug 2024
Historique:
received:
18
07
2023
accepted:
30
07
2024
medline:
15
8
2024
pubmed:
15
8
2024
entrez:
14
8
2024
Statut:
epublish
Résumé
Owing to a lack of data, this study aimed to explore the effect of cardiac preload on myocardial strain in patients with sepsis. A total of 70 patients with sepsis in intensive care unit (ICU) of a tertiary teaching hospital in China from January 2018 to July 2019 and underwent transthoracic echocardiography were enrolled. Echocardiographic data were recorded at ICU admission and 24 h later. Patients were assigned to low left ventricular end-diastolic volume index (LVEDVI) and normal LVEDVI groups. We assessed the impact of preload on myocardial strain between the groups and analyzed the correlation of echocardiographic parameters under different preload conditions. Thirty-seven patients (53%) had a low LVEDVI and 33 (47%) a normal LVEDVI. Those in the low LVEDVI group had a faster heart rate (121.7 vs. 95.3, p < 0.001) and required a greater degree of fluid infusion (3.67 L vs. 2.62 L, P = 0.019). The left ventricular global strain (LVGLS) (-8.60% vs. -10.80%, p = 0.001), left ventricular global circumferential strain (LVGCS) (-13.83% vs. -18.26%, p = 0.006), and right ventricular global longitudinal strain (RVGLS) (-6.9% vs. -10.60%, p = 0.001) showed significant improvements in the low LVEDVI group after fluid resuscitation. However, fluid resuscitation resulted in a significantly increased cardiac afterload value (1172.00 vs. 1487.00, p = 0.009) only in the normal LVEDVI group. Multivariate backward linear regression showed that LVEDVI changes were independently associated with myocardial strain-related improvements during fluid resuscitation. The baseline LVEDVI was significantly negatively correlated with the LVGLS and RVGLS (r = -0.44 and - 0.39, respectively) but not LVGCS. LVEDVI increases during fluid resuscitation were associated with improvements in the myocardial strain degree. Myocardial strain alterations were significantly influenced by the cardiac preload during fluid resuscitation in sepsis.
Sections du résumé
BACKGROUND
BACKGROUND
Owing to a lack of data, this study aimed to explore the effect of cardiac preload on myocardial strain in patients with sepsis.
METHODS
METHODS
A total of 70 patients with sepsis in intensive care unit (ICU) of a tertiary teaching hospital in China from January 2018 to July 2019 and underwent transthoracic echocardiography were enrolled. Echocardiographic data were recorded at ICU admission and 24 h later. Patients were assigned to low left ventricular end-diastolic volume index (LVEDVI) and normal LVEDVI groups. We assessed the impact of preload on myocardial strain between the groups and analyzed the correlation of echocardiographic parameters under different preload conditions.
RESULTS
RESULTS
Thirty-seven patients (53%) had a low LVEDVI and 33 (47%) a normal LVEDVI. Those in the low LVEDVI group had a faster heart rate (121.7 vs. 95.3, p < 0.001) and required a greater degree of fluid infusion (3.67 L vs. 2.62 L, P = 0.019). The left ventricular global strain (LVGLS) (-8.60% vs. -10.80%, p = 0.001), left ventricular global circumferential strain (LVGCS) (-13.83% vs. -18.26%, p = 0.006), and right ventricular global longitudinal strain (RVGLS) (-6.9% vs. -10.60%, p = 0.001) showed significant improvements in the low LVEDVI group after fluid resuscitation. However, fluid resuscitation resulted in a significantly increased cardiac afterload value (1172.00 vs. 1487.00, p = 0.009) only in the normal LVEDVI group. Multivariate backward linear regression showed that LVEDVI changes were independently associated with myocardial strain-related improvements during fluid resuscitation. The baseline LVEDVI was significantly negatively correlated with the LVGLS and RVGLS (r = -0.44 and - 0.39, respectively) but not LVGCS. LVEDVI increases during fluid resuscitation were associated with improvements in the myocardial strain degree.
CONCLUSIONS
CONCLUSIONS
Myocardial strain alterations were significantly influenced by the cardiac preload during fluid resuscitation in sepsis.
Identifiants
pubmed: 39143461
doi: 10.1186/s12872-024-04083-8
pii: 10.1186/s12872-024-04083-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
426Informations de copyright
© 2024. The Author(s).
Références
Sanfilippo F, Corredor C, Fletcher N, Tritapepe L, Lorini FL, Arcadipane A, Vieillard-Baron A, Cecconi M. Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock: a systematic review and meta-analysis. Crit Care. 2018;22(1):183.
doi: 10.1186/s13054-018-2113-y
pubmed: 30075792
pmcid: 6091069
Pruszczyk A, Zawadka M, Andruszkiewicz P, LaVia L, Herpain A, Sato R, Dugar S, Chew MS, Sanfilippo F. Mortality in patients with septic cardiomyopathy identified by longitudinal strain by speckle tracking echocardiography: an updated systematic review and meta-analysis with trial sequential analysis. Anaesth Crit Care Pain Med. 2024;43(2):101339.
doi: 10.1016/j.accpm.2023.101339
pubmed: 38128732
Gorcsan J 3rd, Tanaka H. Echocardiographic assessment of myocardial strain. J Am Coll Cardiol. 2011;58(14):1401–13.
doi: 10.1016/j.jacc.2011.06.038
pubmed: 21939821
Brady B, King G, Murphy RT, Walsh D. Myocardial strain: a clinical review. Ir J Med Sci. 2023;192(4):1649–56.
doi: 10.1007/s11845-022-03210-8
pubmed: 36380189
Onishi T, Saha SK, Delgado-Montero A, Ludwig DR, Onishi T, Schelbert EB, Schwartzman D, Gorcsan J. 3rd: global longitudinal strain and global circumferential strain by speckle-tracking echocardiography and feature-tracking cardiac magnetic resonance imaging: comparison with left ventricular ejection fraction. J Am Soc Echocardiogr. 2015;28(5):587–96.
doi: 10.1016/j.echo.2014.11.018
pubmed: 25577185
Shahul S, Gulati G, Hacker MR, Mahmood F, Canelli R, Nizamuddin J, Mahmood B, Mueller A, Simon BA, Novack V, et al. Detection of myocardial dysfunction in septic shock: a speckle-tracking Echocardiography Study. Anesth Analg. 2015;121(6):1547–54.
doi: 10.1213/ANE.0000000000000943
pubmed: 26397444
Yan X, Li Y, Liu J, Zhou T, Zhou Y, Sun W, Sun C, Ma J, Zhang L, Shang Y, et al. Serial changes in left ventricular myocardial deformation in sepsis or septic shock using three-dimensional and two-dimensional speckle tracking echocardiography. Front Cardiovasc Med. 2022;9:925367.
doi: 10.3389/fcvm.2022.925367
pubmed: 35990934
pmcid: 9386176
Nafati C, Gardette M, Leone M, Reydellet L, Blasco V, Lannelongue A, Sayagh F, Wiramus S, Antonini F, Albanese J, et al. Use of speckle-tracking strain in preload-dependent patients, need for cautious interpretation! Ann Intensive Care. 2018;8(1):29.
doi: 10.1186/s13613-018-0376-8
pubmed: 29468335
pmcid: 5821613
Urheim S, Edvardsen T, Torp H, Angelsen B, Smiseth OA. Myocardial strain by Doppler echocardiography. Validation of a new method to quantify regional myocardial function. Circulation. 2000;102(10):1158–64.
doi: 10.1161/01.CIR.102.10.1158
pubmed: 10973846
Negishi K, Borowski AG, Popovic ZB, Greenberg NL, Martin DS, Bungo MW, Levine BD, Thomas JD. Effect of gravitational gradients on Cardiac Filling and Performance. J Am Soc Echocardiogr. 2017;30(12):1180–8.
doi: 10.1016/j.echo.2017.08.005
pubmed: 29056408
Burns AT, La Gerche A, D’Hooge J, MacIsaac AI, Prior DL. Left ventricular strain and strain rate: characterization of the effect of load in human subjects. Eur J Echocardiogr. 2010;11(3):283–9.
doi: 10.1093/ejechocard/jep214
pubmed: 20026455
Dahle GO, Stangeland L, Moen CA, Salminen PR, Haaverstad R, Matre K, Grong K. The influence of acute unloading on left ventricular strain and strain rate by speckle tracking echocardiography in a porcine model. Am J Physiol Heart Circ Physiol. 2016;310(10):H1330–1339.
doi: 10.1152/ajpheart.00947.2015
pubmed: 26968547
pmcid: 4895836
Andersen NH, Terkelsen CJ, Sloth E, Poulsen SH. Influence of preload alterations on parameters of systolic left ventricular long-axis function: a Doppler tissue study. J Am Soc Echocardiogr. 2004;17(9):941–7.
doi: 10.1016/j.echo.2004.05.004
pubmed: 15337958
Scheuren K, Wente MN, Hainer C, Scheffler M, Lichtenstern C, Martin E, Schmidt J, Bopp C, Weigand MA. Left ventricular end-diastolic area is a measure of cardiac preload in patients with early septic shock. Eur J Anaesthesiol. 2009;26(9):759–65.
doi: 10.1097/EJA.0b013e32832a3a9c
pubmed: 19390446
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, et al. The Third International Consensus definitions for Sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10.
doi: 10.1001/jama.2016.0287
pubmed: 26903338
pmcid: 4968574
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, et al. Surviving Sepsis Campaign: International guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486–552.
doi: 10.1097/CCM.0000000000002255
pubmed: 28098591
Chahal NS, Lim TK, Jain P, Chambers JC, Kooner JS, Senior R. Population-based reference values for 3D echocardiographic LV volumes and ejection fraction. JACC Cardiovasc Imaging. 2012;5(12):1191–7.
doi: 10.1016/j.jcmg.2012.07.014
pubmed: 23236967
Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, Morehead A, Kitzman D, Oh J, Quinones M, et al. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr. 2004;17(10):1086–119.
pubmed: 15452478
Kosmala W, Przewlocka-Kosmala M, Sharman JE, Schultz MG, Marwick TH. Stability of left ventricular longitudinal and circumferential deformation over time and standard loading conditions. Eur Heart J Cardiovasc Imaging. 2017;18(9):1001–7.
doi: 10.1093/ehjci/jew135
pubmed: 27369851
Stokke TM, Hasselberg NE, Smedsrud MK, Sarvari SI, Haugaa KH, Smiseth OA, Edvardsen T, Remme EW. Geometry as a Confounder when assessing ventricular systolic function: comparison between ejection fraction and strain. J Am Coll Cardiol. 2017;70(8):942–54.
doi: 10.1016/j.jacc.2017.06.046
pubmed: 28818204
Fredholm M, Jorgensen K, Houltz E, Ricksten SE. Load-dependence of myocardial deformation variables - a clinical strain-echocardiographic study. Acta Anaesthesiol Scand. 2017;61(9):1155–65.
doi: 10.1111/aas.12954
pubmed: 28804896
Boissier F, Razazi K, Seemann A, Bedet A, Thille AW, de Prost N, Lim P, Brun-Buisson C, Mekontso Dessap A. Left ventricular systolic dysfunction during septic shock: the role of loading conditions. Intensive Care Med. 2017;43(5):633–42.
doi: 10.1007/s00134-017-4698-z
pubmed: 28204860
Ng PY, Sin WC, Ng AK, Chan WM. Speckle tracking echocardiography in patients with septic shock: a case control study (SPECKSS). Crit Care. 2016;20(1):145.
doi: 10.1186/s13054-016-1327-0
pubmed: 27177587
pmcid: 4867983
Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, Christophi C, Leslie K, McGuinness S, Parke R, et al. Restrictive versus liberal fluid therapy for major abdominal surgery. N Engl J Med. 2018;378(24):2263–74.
doi: 10.1056/NEJMoa1801601
pubmed: 29742967
Marik P, Bellomo R. A rational approach to fluid therapy in sepsis. Br J Anaesth. 2016;116(3):339–49.
doi: 10.1093/bja/aev349
pubmed: 26507493
Sengupta PP, Korinek J, Belohlavek M, Narula J, Vannan MA, Jahangir A, Khandheria BK. Left ventricular structure and function: basic science for cardiac imaging. J Am Coll Cardiol. 2006;48(10):1988–2001.
doi: 10.1016/j.jacc.2006.08.030
pubmed: 17112989
Sengupta PP, Tajik AJ, Chandrasekaran K, Khandheria BK. Twist mechanics of the left ventricle: principles and application. JACC Cardiovasc Imaging. 2008;1(3):366–76.
doi: 10.1016/j.jcmg.2008.02.006
pubmed: 19356451
Riffel JH, Keller MG, Rost F, Arenja N, Andre F, Aus dem Siepen F, Fritz T, Ehlermann P, Taeger T, Frankenstein L, et al. Left ventricular long axis strain: a new prognosticator in non-ischemic dilated cardiomyopathy? J Cardiovasc Magn Reson. 2016;18(1):36.
doi: 10.1186/s12968-016-0255-0
pubmed: 27268238
pmcid: 4897821
Friedberg MK. Imaging right-left ventricular interactions. JACC Cardiovasc Imaging. 2018;11(5):755–71.
doi: 10.1016/j.jcmg.2018.01.028
pubmed: 29747850
Lemarie J, Maigrat CH, Kimmoun A, Dumont N, Bollaert PE, Selton-Suty C, Gibot S, Huttin O. Feasibility, reproducibility and diagnostic usefulness of right ventricular strain by 2-dimensional speckle-tracking echocardiography in ARDS patients: the ARD strain study. Ann Intensive Care. 2020;10(1):24.
doi: 10.1186/s13613-020-0636-2
pubmed: 32056017
pmcid: 7018922
Lopez-Candales A, Rajagopalan N, Saxena N, Gulyasy B, Edelman K, Bazaz R. Right ventricular systolic function is not the sole determinant of tricuspid annular motion. Am J Cardiol. 2006;98(7):973–7.
doi: 10.1016/j.amjcard.2006.04.041
pubmed: 16996886
Bosch L, Lam CSP, Gong L, Chan SP, Sim D, Yeo D, Jaufeerally F, Leong KTG, Ong HY, Ng TP, et al. Right ventricular dysfunction in left-sided heart failure with preserved versus reduced ejection fraction. Eur J Heart Fail. 2017;19(12):1664–71.
doi: 10.1002/ejhf.873
pubmed: 28597497
Marwick TH. Ejection Fraction pros and cons: JACC State-of-the-art review. J Am Coll Cardiol. 2018;72(19):2360–79.
doi: 10.1016/j.jacc.2018.08.2162
pubmed: 30384893
Cikes M, Solomon SD. Beyond ejection fraction: an integrative approach for assessment of cardiac structure and function in heart failure. Eur Heart J. 2016;37(21):1642–50.
doi: 10.1093/eurheartj/ehv510
pubmed: 26417058