Consultant Anaesthesiology & Intensive Care AZ Delta
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Introduction: Myocardial dysfunction is common in septic shock and may be linked to poor outcomes. Traditional measures such as left ventricular ejection fraction (LVEF) may lack sensitivity for detecting early cardiac impairment. Global longitudinal strain (GLS), assessed by speckle-tracking echocardiography, may better characterise biventricular dysfunction. This study evaluates the association between biventricular GLS, LVEF, and in-hospital mortality in septic shock patients.
Methods: We retrospectively evaluated ICU patients with septic shock (SEPSIS-III criteria) admitted to a single centre between March and September 2024 who underwent transthoracic echocardiography, performed as standard of care. After exclusion of cases with poor echocardiographic image quality or pre-existing cardiac disease, 18 patients were included for analysis. Retrospective speckle-tracking analysis using PHILIPS TOMTEC was performed to quantify left ventricular GLS from apical 4-, 3-, and 2-chamber views, and right ventricular GLS from a modified RV view. Left ventricular ejection fraction (LVEF) was measured using the Simpson method on apical 4-chamber views. Survival status was determined at hospital discharge. Continuous variables are reported as median (interquartile range, IQR) and compared using Mann-Whitney U tests due to non-normal data distribution.
Results: Four (22%) of 18 patients died in hospital. RV GLS was significantly less negative among non‑survivors (median −9.2%, IQR −7.7 to −10.8) compared to survivors (median −15.5%, IQR −15.0 to −17.7; p = 0.029). LV GLS was also less negative in non‑survivors (median −15.2%, IQR −15.2 to −15.3) than survivors (median −17.8%, IQR −16.4 to −18.7; p = 0.11). LVEF was numerically lower in non‑survivors (median 48.9%, IQR 45.2–52.0) versus survivors (median 54.9%, IQR 49.6–63.6; p = 0.14).
Conclusions: In this cohort of septic shock ICU patients, impaired RV GLS was significantly associated with in‑hospital mortality, while LV GLS and LVEF exhibited similar trends. These findings suggest that GLS—particularly RV GLS—may provide additional prognostic information beyond LVEF. Larger, prospective, multicentre studies are required.
