Sepsis-induced myocardial dysfunction diagnosed with strain versus non-strain echocardiography parameters: incidence, evolution and association with prognosis
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Gonzalez,Filipe André;Bacariza,Jacobo;Varudo,Ana Rita;Leote,João;Mateus,Ricardo Meireles;Martins,Cristina Maia;Ribeiro,Maria Inês;Sanfilippo,Filippo;Lopes,LuÃs Rocha;Almeida,Ana G.
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2025
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Article
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BACKGROUND: Sepsis-induced myocardial dysfunction (SIMD) remains poorly defined due to scarce longitudinal studies with advanced echocardiography. We characterized SIMD progression using speckle tracking echocardiography (STE). METHODS: Prospective single-center study in septic shock patients admitted to intensive care. SIMD was defined as any left ventricular (LV, systolic and/or diastolic) and/or right ventricular (RV) systolic dysfunction, using STE or non-STE criteria, on days 1, 7 and 30. We studied prevalence, evolution and prognosis of SIMD classified with either criteria using Cox regression. RESULTS: Ninety-eight consecutive patients were included. On day 1, SIMD was identified in n = 57/98 (58.2%) and n = 70/98 (71.4%;p = 0.072) by non-STE and STE parameters, respectively. No significant difference in diagnosis was seen for LV diastolic dysfunction: n = 50/98 (51.0%, non-STE) vs. n = 51/98 (52.0%, STE; p = 1.00). Prevalences of LV and RV systolic dysfunction were not significantly higher with STE criteria: n = 59/98 (60.2%, STE) vs. n = 47/98 (48.0%, non-STE; p = 0.115) for LV; n = 39/98 (39.8%, STE) vs. n = 27/98 (27.6%, non-STE; p = 0.096) for RV. More patients recovered from SIMD when evaluated with non-STE criteria at day 7 (35.3% vs. 17.5% STE; p = 0.033), but not at day 30 (24.5% vs. 18.8% STE; p = 0.501). The 30-day mortality (n = 33/98, 33.7%) was associated with SIMD diagnosed using non-STE (p = 0.010), but not with STE (p = 0.057). In Cox regression, only LVDD by non-STE criteria predicted 30-day mortality (p = 0.005). CONCLUSIONS: The incidence of SIMD in septic shock is higher when using STE criteria, with lower reversibility in the first week. A broad definition of SIMD utilizing STE criteria does not seem to provide additional prognostic value. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05552521 registered on the 20th of September 2022.
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Annals of intensive care
Volume
15
Issue
1