Use of speckle-tracking strain in preload-dependent patients, need for cautious interpretation!
Use of speckle-tracking strain in preload-dependent patients, need for cautious interpretation!
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DOI：
10.1186/s13613-018-0376-8
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发表时间：
2018-02-21
影响因子：
8.1
通讯作者：
Zieleskiewicz, L.
中科院分区：
文献类型：
--
作者：
Nafati, C.;Gardette, M.;Zieleskiewicz, L.
背景：在危重患者中，左心室射血分数和分数缩短被用来反映左心室收缩功能。一种新兴技术，二维应变超声心动图，可以评估左心室收缩纵向变形（整体纵向应变）和这种变形发生的速度（收缩应变率）。这项技术越来越多地用于重症监护病房的危重患者和预负荷不断变化的围手术期。在这项前瞻性单中心观察性研究中，我们的目的是评估液体复苏对预负荷依赖危重患者二维应变超声心动图测量的影响。我们纳入了49例预负荷依赖患者，在被动抬腿操作期间，超声心动图测量的左心室流出道速度-时间积分增加至少10%。在液体复苏前（超声心动图1）和实现负荷独立后（超声心动图2）进行超声心动图检查。结果：49例患者中40例（82%）二维应变超声心动图是可行的。预载荷相关性校正后，整体纵向应变和收缩应变率的绝对值分别从-13.3 +/- 3.5和-1.11 s(-1) +/- 0.29显著增加到-1.55 s(-1) +/- 0.55 （p < 0.001）。液体复苏影响预负荷依赖患者的GLS和SSR， GLS从病理学值转变为正常值。结论：在危重患者中，通过二维应变超声心动图评估收缩功能需要预先评估预负荷依赖性，以便充分解释这一变量。未来的研究应评估整体纵向应变的能力，以指导重症患者的流体管理。
Background: In critical patients, left ventricular ejection fraction and fractional shortening are used to reflect left ventricular systolic function. An emerging technique, two-dimensional-strain echocardiography, allows assessment of the left ventricle systolic longitudinal deformation (global longitudinal strain) and the speed at which this deformation occurs (systolic strain rate). This technique is of increasing use in critical patients in intensive care units and in the peri-operative period where preload constantly varies. Our objective, in this prospective single-center observational study, was to evaluate the effect of fluid resuscitation on two-dimensional-strain echocardiography measurements in preload-dependent critically ill patients. We included 49 patients with preload dependence attested by an increase of at least 10% in the left ventricular outflow track velocity-time integral measured by echocardiography during a passive leg raising maneuver. Echocardiography was performed before fluid resuscitation (echocardiography 1) and after preload independency achievement (echocardiography 2).Results: Two-dimensional-strain echocardiography was feasible in 40 (82%) among the 49 patients. With preload dependence correction, the absolute value of global longitudinal strain and systolic strain rate was significantly increased from, respectively, -13.3 +/- 3.5 to -18.4% +/- 4.5 (p < 0.01) and -1.11 s(-1) +/- 0.29 to -1.55 s(-1) +/- 0.55 (p < 0.001). The fluid resuscitation affects GLS and SSR in preload-dependent patients, with a shift, for GLS, from pathological to normal values.Conclusion: In critically ill patients, the assessment of the systolic function by two-dimensional-strain echocardiography needs prior evaluation of preload dependency, in order to adequately interpret this variable. Future studies should assess the ability of global longitudinal strain to guide fluid management in the critically ill patients.