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Observational Study
. 2023 Apr-Jun;35(2):187-195.
doi: 10.5935/2965-2774.20230378-en.

The predictive value of left ventricular global longitudinal strain in normotensive critically ill septic patients

[Article in English, Portuguese]
Timor Omar  1 , Kamil İnci  2 , Yusuf Oflu  2 , Mustafa Dilek  2 , Zeynep Binici Çelik  2 , Soner Kına  2 , Doğan İliş  2 , Halil Murat Bucak  2
Affiliations
Observational Study

The predictive value of left ventricular global longitudinal strain in normotensive critically ill septic patients

[Article in English, Portuguese]
Timor Omar et al. Crit Care Sci. 2023 Apr-Jun.

Abstract

Objective: Evaluation of left ventricular systolic function using speckle tracking echocardiography is more sensitive than conventional echocardiographic measurement in detecting subtle left ventricular dysfunction in septic patients. Our purpose was to investigate the predictive significance of left ventricular global longitudinal strain in normotensive septic intensive care patients.

Methods: This observational, prospective cohort study included septic normotensive adults admitted to the intensive care unit between June 1, 2021, and August 31, 2021. Left ventricular systolic function was measured using speckle-tracking echocardiography within 24 hours of admission.

Results: One hundred fifty-two patients were enrolled. The intensive care unit mortality rate was 27%. Left ventricular global longitudinal strain was less negative, which indicated worse left ventricular function in non-survivors than survivors (median [interquartile range], -15.2 [-17.2 - -12.5] versus -17.3 [-18.8 - -15.5]; p < 0.001). The optimal cutoff value for left ventricular global longitudinal strain was -17% in predicting intensive care unit mortality (area under the curve, 0.728). Patients with left ventricular global longitudinal strain > -17% (less negative than -17%, which indicated worse left ventricular function) showed a significantly higher mortality rate (39.2% versus 13.7%; p < 0.001). According to multivariate analysis, left ventricular global longitudinal strain was an independent predictor of intensive care unit mortality [OR (95%CI), 1.326 (1.038 - 1.693); p = 0.024], along with invasive mechanical ventilation and Glasgow coma scale, APACHE II, and SOFA risk scores.

Conclusion: Impaired left ventricular global longitudinal strain is associated with mortality and provided predictive data in normotensive septic intensive care patients.

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Figures

Figure 1
Figure 1
An example of left ventricular global longitudinal strain speckle tracking of a patient from the apical 4-chamber (A), 2-chamber (B), and 3-chamber (C) views. (D) The bullseye view of 17 ventricular segments from the apical 4-chamber, 3-chamber, and 2-chamber views.
Figure 2
Figure 2
Receiver operating characteristic curve for prediction of intensive care unit mortality using the left ventricular global longitudinal strain. The area under the curve is 0.73 (cutoff: -17%, sensitivity: 73%, specificity: 57%).
Figure 3
Figure 3
Correlation graphics between the left ventricular global longitudinal strain and left ventricular ejection fraction (A), and troponin T (B).
See this image and copyright information in PMC

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