title: Left ventricular global longitudinal strain is independently associated with mortality in septic shock patients.
abstract: OBJECTIVE
  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 ≥ -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.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Chang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd. North District, Tainan, 704, Taiwan.
authors.forename: Wen-Huang
authors.initials: WH
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd. North District, Tainan, 704, Taiwan.|Division of Intensive Care Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd. North District, Tainan, 704, Taiwan.|Division of Intensive Care Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Po-Sheng
authors.initials: PS
authors.lastname: Chen
authors.affiliation: Biostatistics, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Yu-Ru
authors.initials: YR
authors.lastname: Su
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd. North District, Tainan, 704, Taiwan.
authors.forename: Ping-Yen
authors.initials: PY
authors.lastname: Liu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd. North District, Tainan, 704, Taiwan. wen036030@gmail.com.
authors.forename: Yen-Wen
authors.initials: YW
authors.lastname: Liu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd. North District, Tainan, 704, Taiwan. wctsai@ksmail.seed.net.tw.
authors.forename: Wei-Chuan
authors.initials: WC
authors.lastname: Tsai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003422:Critical Care / Q000379:methods*; D019560:Echocardiography, Three-Dimensional; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012307:Risk Factors; D012772:Shock, Septic / Q000401:mortality* / Q000503:physiopathology*; D017741:Survivors / Q000706:statistics & numerical data*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology*
keywords: Global longitudinal strain; Intensive care; Mortality; Septic shock; Speckle tracking echocardiography