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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.

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Acknowledgments

This study was supported by the National Cheng Kung University Hospital. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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    Authors and Affiliations

    1. Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan

      Wei-Ting Chang

    2. Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd. North District, Tainan, 704, Taiwan

      Wen-Huang Lee, Wei-Ting Lee, Po-Sheng Chen, Ping-Yen Liu, Yen-Wen Liu & Wei-Chuan Tsai

    3. Division of Intensive Care Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

      Wei-Ting Lee & Po-Sheng Chen

    4. Biostatistics, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

      Yu-Ru Su

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    Correspondence to Yen-Wen Liu or Wei-Chuan Tsai.

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    Additional information

    W.-T. Chang and W.-H. Lee equally contribute to this work.

    Take-home message: In addition to APACHE II score, left ventricular longitudinal strain provides prognostic information as an outcome predictor for mortality of septic patients in ICU. This study will help clinical practitioners in evaluating the severity of disease and initiating early interventions.

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    Chang, WT., Lee, WH., Lee, WT. et al. Left ventricular global longitudinal strain is independently associated with mortality in septic shock patients. Intensive Care Med 41, 1791–1799 (2015). https://doi.org/10.1007/s00134-015-3970-3

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    • DOI: https://doi.org/10.1007/s00134-015-3970-3

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