Left ventricular global longitudinal strain is independently associated with mortality in septic shock patients
Left ventricular global longitudinal strain is independently associated with mortality in septic shock patients
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DOI：
10.1007/s00134-015-3970-3
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发表时间：
2015-10-01
影响因子：
38.9
通讯作者：
Tsai, Wei-Chuan
中科院分区：
文献类型：
--
作者：
Chang, Wei-Ting;Lee, Wen-Huang;Tsai, Wei-Chuan
目的常规超声心动图不能发现脓毒症患者的轻微心功能不全。二维左心室（LV）整体收缩期峰值纵向应变（GLS）可以检测早期心功能不全。我们试图确定GLS对重症监护病房（ICU）感染性休克患者的预后价值。方法我们前瞻性地纳入了111例ICU感染性休克患者。记录每例患者的完整病史，并测量LV收缩功能，包括GLS。结果ICU死亡率为31.5%（n = 35），住院死亡率为35.1%（n = 39）.死亡者和存活者的左心室射血分数无显著差异;然而，在ICU入院时，死亡者的GLS阴性程度低于存活者，这表明左心室收缩功能较差。-13%的GLS在预测死亡率方面表现出最佳的灵敏度和特异性（曲线下面积0.79）。患有GLS的患者表现出更高的ICU和医院死亡率（风险比分别为4.34，p < 0.001和4.21，p < 0.001）。考克斯回归分析显示，较高的急性生理学和慢性健康评估（APACHE）II评分和较少的阴性GLS是ICU和医院死亡率的独立预测因子。GLS被发现添加预后信息的APACHE II score.Conclusions这些研究结果表明，结合GLS和APACHE II评分在ICU和医院死亡率的预测具有附加价值，GLS可能有助于早期识别高危感染性休克患者在ICU。
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 a parts per thousand yen -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.