Left ventricular global longitudinal strain is independently associated with mortality in septic shock patients

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Abstract

Purpose: Conventional echocardiography may not detect subtle cardiac dysfunction of septic patients. Two-dimensional left ventricular (LV) global peak systolic longitudinal strain (GLS) can detect early cardiac dysfunction. We sought to determine the prognostic value of GLS for septic shock patients admitted to intensive care units (ICUs). Methods: We prospectively included 111 ICU patients with septic shock. A full medical history was recorded for each patient, and LV systolic function, including GLS, was measured. Our endpoints were ICU and hospital mortality. Results: The ICU and hospital mortalities were 31.5 % (n = 35) and 35.1 % (n = 39), respectively. There was no significant difference in LV ejection fraction of the non-survivors and the survivors; however, upon ICU admission, the non-survivors exhibited GLSs that were less negative than those of the survivors, which indicated worse LV systolic function. GLS of −13 % presented the best sensitivity and specificity in the prediction of mortality (area under the curve 0.79). The patients with GLS ≥ −13 % exhibited higher ICU and hospital mortality rates (hazard ratio 4.34, p < 0.001 and hazard ratio 4.21, p < 0.001, respectively). Cox regression analyses revealed that higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores and less negative GLSs were independent predictors of ICU and hospital mortalities. GLS was found to add prognostic information to the APACHE II score. Conclusions: These findings suggest that combining GLS and the APACHE II score has additive value in the prediction of ICU and hospital mortalities and that GLS may help in early identification of high-risk septic shock patients in ICU.

Original languageEnglish
Pages (from-to)1791-1799
Number of pages9
JournalIntensive Care Medicine
Volume41
Issue number10
DOIs
Publication statusPublished - 2015 Oct 22

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Septic Shock
Intensive Care Units
Mortality
Hospital Mortality
Left Ventricular Function
Survivors
APACHE
Stroke Volume
Area Under Curve
Echocardiography
Regression Analysis
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

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title = "Left ventricular global longitudinal strain is independently associated with mortality in septic shock patients",
abstract = "Purpose: Conventional echocardiography may not detect subtle cardiac dysfunction of septic patients. Two-dimensional left ventricular (LV) global peak systolic longitudinal strain (GLS) can detect early cardiac dysfunction. We sought to determine the prognostic value of GLS for septic shock patients admitted to intensive care units (ICUs). Methods: We prospectively included 111 ICU patients with septic shock. A full medical history was recorded for each patient, and LV systolic function, including GLS, was measured. Our endpoints were ICU and hospital mortality. Results: The ICU and hospital mortalities were 31.5 {\%} (n = 35) and 35.1 {\%} (n = 39), respectively. There was no significant difference in LV ejection fraction of the non-survivors and the survivors; however, upon ICU admission, the non-survivors exhibited GLSs that were less negative than those of the survivors, which indicated worse LV systolic function. GLS of −13 {\%} presented the best sensitivity and specificity in the prediction of mortality (area under the curve 0.79). The patients with GLS ≥ −13 {\%} exhibited higher ICU and hospital mortality rates (hazard ratio 4.34, p < 0.001 and hazard ratio 4.21, p < 0.001, respectively). Cox regression analyses revealed that higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores and less negative GLSs were independent predictors of ICU and hospital mortalities. GLS was found to add prognostic information to the APACHE II score. Conclusions: These findings suggest that combining GLS and the APACHE II score has additive value in the prediction of ICU and hospital mortalities and that GLS may help in early identification of high-risk septic shock patients in ICU.",
author = "Chang, {Wei Ting} and Wen-Huang Li and Wei-Ting Lee and Po-Sheng Chen and Su, {Yu Ru} and Ping-Yen Liu and Yen-Wen Liu and Wei-Chuan Tsai",
year = "2015",
month = "10",
day = "22",
doi = "10.1007/s00134-015-3970-3",
language = "English",
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TY - JOUR

T1 - Left ventricular global longitudinal strain is independently associated with mortality in septic shock patients

AU - Chang, Wei Ting

AU - Li, Wen-Huang

AU - Lee, Wei-Ting

AU - Chen, Po-Sheng

AU - Su, Yu Ru

AU - Liu, Ping-Yen

AU - Liu, Yen-Wen

AU - Tsai, Wei-Chuan

PY - 2015/10/22

Y1 - 2015/10/22

N2 - Purpose: Conventional echocardiography may not detect subtle cardiac dysfunction of septic patients. Two-dimensional left ventricular (LV) global peak systolic longitudinal strain (GLS) can detect early cardiac dysfunction. We sought to determine the prognostic value of GLS for septic shock patients admitted to intensive care units (ICUs). Methods: We prospectively included 111 ICU patients with septic shock. A full medical history was recorded for each patient, and LV systolic function, including GLS, was measured. Our endpoints were ICU and hospital mortality. Results: The ICU and hospital mortalities were 31.5 % (n = 35) and 35.1 % (n = 39), respectively. There was no significant difference in LV ejection fraction of the non-survivors and the survivors; however, upon ICU admission, the non-survivors exhibited GLSs that were less negative than those of the survivors, which indicated worse LV systolic function. GLS of −13 % presented the best sensitivity and specificity in the prediction of mortality (area under the curve 0.79). The patients with GLS ≥ −13 % exhibited higher ICU and hospital mortality rates (hazard ratio 4.34, p < 0.001 and hazard ratio 4.21, p < 0.001, respectively). Cox regression analyses revealed that higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores and less negative GLSs were independent predictors of ICU and hospital mortalities. GLS was found to add prognostic information to the APACHE II score. Conclusions: These findings suggest that combining GLS and the APACHE II score has additive value in the prediction of ICU and hospital mortalities and that GLS may help in early identification of high-risk septic shock patients in ICU.

AB - Purpose: Conventional echocardiography may not detect subtle cardiac dysfunction of septic patients. Two-dimensional left ventricular (LV) global peak systolic longitudinal strain (GLS) can detect early cardiac dysfunction. We sought to determine the prognostic value of GLS for septic shock patients admitted to intensive care units (ICUs). Methods: We prospectively included 111 ICU patients with septic shock. A full medical history was recorded for each patient, and LV systolic function, including GLS, was measured. Our endpoints were ICU and hospital mortality. Results: The ICU and hospital mortalities were 31.5 % (n = 35) and 35.1 % (n = 39), respectively. There was no significant difference in LV ejection fraction of the non-survivors and the survivors; however, upon ICU admission, the non-survivors exhibited GLSs that were less negative than those of the survivors, which indicated worse LV systolic function. GLS of −13 % presented the best sensitivity and specificity in the prediction of mortality (area under the curve 0.79). The patients with GLS ≥ −13 % exhibited higher ICU and hospital mortality rates (hazard ratio 4.34, p < 0.001 and hazard ratio 4.21, p < 0.001, respectively). Cox regression analyses revealed that higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores and less negative GLSs were independent predictors of ICU and hospital mortalities. GLS was found to add prognostic information to the APACHE II score. Conclusions: These findings suggest that combining GLS and the APACHE II score has additive value in the prediction of ICU and hospital mortalities and that GLS may help in early identification of high-risk septic shock patients in ICU.

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U2 - 10.1007/s00134-015-3970-3

DO - 10.1007/s00134-015-3970-3

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VL - 41

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JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

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