Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock: A systematic review and meta-analysis

F. Sanfilippo, C. Corredor, N. Fletcher, L. Tritapepe, F. L. Lorini, A. Arcadipane, A. Vieillard-Baron, M. Cecconi

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Sepsis-induced myocardial dysfunction is associated with poor outcomes, but traditional measurements of systolic function such as left ventricular ejection fraction (LVEF) do not directly correlate with prognosis. Global longitudinal strain (GLS) utilizing speckle-tracking echocardiography (STE) could be a better marker of intrinsic left ventricular (LV) function, reflecting myocardial deformation rather than displacement and volume changes. We sought to investigate the prognostic value of GLS in patients with sepsis and/or septic shock. Methods: We conducted a systematic review (PubMed and Embase up to 26 October 2017) and meta-analysis to investigate the association between GLS and mortality at longest follow up in patients with severe sepsis and/or septic shock. In the primary analysis, we included studies reporting transthoracic echocardiography data on GLS according to mortality. A secondary analysis evaluated the association between LVEF and mortality including data from studies reporting GLS. Results: We included eight studies in the primary analysis with a total of 794 patients (survival 68%, n=540). We found a significant association between worse LV function and GLS values and mortality: standard mean difference (SMD) -0.26; 95% confidence interval (CI) -0.47, -0.04; p=0.02 (low heterogeneity, I 2=43%). No significant association was found between LVEF and mortality in the same population of patients (eight studies; SMD, 0.02; 95% CI -0.14, 0.17; p=0.83; no heterogeneity, I 2=3%). Conclusions: Worse GLS (less negative)values are associated with higher mortality in patients with severe sepsis or septic shock, while such association is not valid for LVEF. More critical care research is warranted to confirm the better ability of STE in demonstrating underlying intrinsic myocardial disease compared to LVEF.

Original languageEnglish
Article number183
JournalCritical Care
Volume22
Issue number1
DOIs
Publication statusPublished - Aug 4 2018

Fingerprint

Septic Shock
Left Ventricular Function
Echocardiography
Meta-Analysis
Sepsis
Stroke Volume
Mortality
Confidence Intervals
Critical Care
Cardiomyopathies
PubMed
Research Design
Survival
Research
Population

Keywords

  • Global longitudinal strain
  • Intensive care
  • Left ventricular ejection fraction
  • Speckle tracking
  • Systolic dysfunction

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock : A systematic review and meta-analysis. / Sanfilippo, F.; Corredor, C.; Fletcher, N.; Tritapepe, L.; Lorini, F. L.; Arcadipane, A.; Vieillard-Baron, A.; Cecconi, M.

In: Critical Care, Vol. 22, No. 1, 183, 04.08.2018.

Research output: Contribution to journalArticle

@article{ec3786905afe44b6b710e2e58d86720b,
title = "Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock: A systematic review and meta-analysis",
abstract = "Background: Sepsis-induced myocardial dysfunction is associated with poor outcomes, but traditional measurements of systolic function such as left ventricular ejection fraction (LVEF) do not directly correlate with prognosis. Global longitudinal strain (GLS) utilizing speckle-tracking echocardiography (STE) could be a better marker of intrinsic left ventricular (LV) function, reflecting myocardial deformation rather than displacement and volume changes. We sought to investigate the prognostic value of GLS in patients with sepsis and/or septic shock. Methods: We conducted a systematic review (PubMed and Embase up to 26 October 2017) and meta-analysis to investigate the association between GLS and mortality at longest follow up in patients with severe sepsis and/or septic shock. In the primary analysis, we included studies reporting transthoracic echocardiography data on GLS according to mortality. A secondary analysis evaluated the association between LVEF and mortality including data from studies reporting GLS. Results: We included eight studies in the primary analysis with a total of 794 patients (survival 68{\%}, n=540). We found a significant association between worse LV function and GLS values and mortality: standard mean difference (SMD) -0.26; 95{\%} confidence interval (CI) -0.47, -0.04; p=0.02 (low heterogeneity, I 2=43{\%}). No significant association was found between LVEF and mortality in the same population of patients (eight studies; SMD, 0.02; 95{\%} CI -0.14, 0.17; p=0.83; no heterogeneity, I 2=3{\%}). Conclusions: Worse GLS (less negative)values are associated with higher mortality in patients with severe sepsis or septic shock, while such association is not valid for LVEF. More critical care research is warranted to confirm the better ability of STE in demonstrating underlying intrinsic myocardial disease compared to LVEF.",
keywords = "Global longitudinal strain, Intensive care, Left ventricular ejection fraction, Speckle tracking, Systolic dysfunction",
author = "F. Sanfilippo and C. Corredor and N. Fletcher and L. Tritapepe and Lorini, {F. L.} and A. Arcadipane and A. Vieillard-Baron and M. Cecconi",
year = "2018",
month = "8",
day = "4",
doi = "10.1186/s13054-018-2113-y",
language = "English",
volume = "22",
journal = "Critical Care",
issn = "1466-609X",
publisher = "Springer Science + Business Media",
number = "1",

}

TY - JOUR

T1 - Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock

T2 - A systematic review and meta-analysis

AU - Sanfilippo, F.

AU - Corredor, C.

AU - Fletcher, N.

AU - Tritapepe, L.

AU - Lorini, F. L.

AU - Arcadipane, A.

AU - Vieillard-Baron, A.

AU - Cecconi, M.

PY - 2018/8/4

Y1 - 2018/8/4

N2 - Background: Sepsis-induced myocardial dysfunction is associated with poor outcomes, but traditional measurements of systolic function such as left ventricular ejection fraction (LVEF) do not directly correlate with prognosis. Global longitudinal strain (GLS) utilizing speckle-tracking echocardiography (STE) could be a better marker of intrinsic left ventricular (LV) function, reflecting myocardial deformation rather than displacement and volume changes. We sought to investigate the prognostic value of GLS in patients with sepsis and/or septic shock. Methods: We conducted a systematic review (PubMed and Embase up to 26 October 2017) and meta-analysis to investigate the association between GLS and mortality at longest follow up in patients with severe sepsis and/or septic shock. In the primary analysis, we included studies reporting transthoracic echocardiography data on GLS according to mortality. A secondary analysis evaluated the association between LVEF and mortality including data from studies reporting GLS. Results: We included eight studies in the primary analysis with a total of 794 patients (survival 68%, n=540). We found a significant association between worse LV function and GLS values and mortality: standard mean difference (SMD) -0.26; 95% confidence interval (CI) -0.47, -0.04; p=0.02 (low heterogeneity, I 2=43%). No significant association was found between LVEF and mortality in the same population of patients (eight studies; SMD, 0.02; 95% CI -0.14, 0.17; p=0.83; no heterogeneity, I 2=3%). Conclusions: Worse GLS (less negative)values are associated with higher mortality in patients with severe sepsis or septic shock, while such association is not valid for LVEF. More critical care research is warranted to confirm the better ability of STE in demonstrating underlying intrinsic myocardial disease compared to LVEF.

AB - Background: Sepsis-induced myocardial dysfunction is associated with poor outcomes, but traditional measurements of systolic function such as left ventricular ejection fraction (LVEF) do not directly correlate with prognosis. Global longitudinal strain (GLS) utilizing speckle-tracking echocardiography (STE) could be a better marker of intrinsic left ventricular (LV) function, reflecting myocardial deformation rather than displacement and volume changes. We sought to investigate the prognostic value of GLS in patients with sepsis and/or septic shock. Methods: We conducted a systematic review (PubMed and Embase up to 26 October 2017) and meta-analysis to investigate the association between GLS and mortality at longest follow up in patients with severe sepsis and/or septic shock. In the primary analysis, we included studies reporting transthoracic echocardiography data on GLS according to mortality. A secondary analysis evaluated the association between LVEF and mortality including data from studies reporting GLS. Results: We included eight studies in the primary analysis with a total of 794 patients (survival 68%, n=540). We found a significant association between worse LV function and GLS values and mortality: standard mean difference (SMD) -0.26; 95% confidence interval (CI) -0.47, -0.04; p=0.02 (low heterogeneity, I 2=43%). No significant association was found between LVEF and mortality in the same population of patients (eight studies; SMD, 0.02; 95% CI -0.14, 0.17; p=0.83; no heterogeneity, I 2=3%). Conclusions: Worse GLS (less negative)values are associated with higher mortality in patients with severe sepsis or septic shock, while such association is not valid for LVEF. More critical care research is warranted to confirm the better ability of STE in demonstrating underlying intrinsic myocardial disease compared to LVEF.

KW - Global longitudinal strain

KW - Intensive care

KW - Left ventricular ejection fraction

KW - Speckle tracking

KW - Systolic dysfunction

UR - http://www.scopus.com/inward/record.url?scp=85051013568&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85051013568&partnerID=8YFLogxK

U2 - 10.1186/s13054-018-2113-y

DO - 10.1186/s13054-018-2113-y

M3 - Article

C2 - 30075792

AN - SCOPUS:85051013568

VL - 22

JO - Critical Care

JF - Critical Care

SN - 1466-609X

IS - 1

M1 - 183

ER -