title: Detection of Myocardial Dysfunction in Septic Shock: A Speckle-Tracking Echocardiography Study.
abstract: BACKGROUND
  Patients with septic shock are at increased risk of myocardial dysfunction. However, the left ventricular ejection fraction (EF) typically remains preserved in septic shock. Strain measurement using speckle-tracking echocardiography may quantify abnormalities in myocardial function not detected by conventional echocardiography. To investigate whether septic shock results in greater strain changes than sepsis alone, we evaluated strain in patients with sepsis and septic shock.
  
  
  METHODS
  We prospectively identified 35 patients with septic shock and 15 with sepsis. These patients underwent serial transthoracic echocardiograms at enrollment and 24 hours later. Measurements included longitudinal, radial, and circumferential strain in addition to standard echocardiographic assessments of left ventricular function.
  
  
  RESULTS
  Longitudinal strain worsened significantly over 24 hours in patients with septic shock (P < 0.0001) but did not change in patients with sepsis alone (P = 0.43). No significant changes in radial or circumferential strain or EF were observed in either group over the 24-hour measurement period. In patients with septic shock, the significant worsening in longitudinal strain persisted after adjustment for left ventricular end-diastolic volume and vasopressor use (P < 0.0001). In patients with sepsis, adjustment for left ventricular end-diastolic volume and vasopressor use did not alter the finding of no significant differences in longitudinal strain (P = 0.48) or EF (P = 0.96).
  
  
  CONCLUSIONS
  In patients with septic shock, but not sepsis, myocardial strain imaging using speckle-tracking echocardiography identified myocardial dysfunction in the absence of changes in EF. These data suggest that strain imaging may play a role in cardiovascular assessment during septic shock.
authors.affiliation: From the *Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; †University of Pennsylvania, Philadelphia, Pennsylvania; ‡Beth Israel Deaconess Medical Center Harvard Medical School, Boston, Massachusetts; §University of Albany Medical School, Albany, New York; ‖Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel; and ¶Faculty of Health Sciences, Ben-Gurion University of Negev, Israel.
authors.forename: Sajid
authors.initials: S
authors.lastname: Shahul
authors.forename: Gaurav
authors.initials: G
authors.lastname: Gulati
authors.forename: Michele R
authors.initials: MR
authors.lastname: Hacker
authors.forename: Feroze
authors.initials: F
authors.lastname: Mahmood
authors.forename: Robert
authors.initials: R
authors.lastname: Canelli
authors.forename: Junaid
authors.initials: J
authors.lastname: Nizamuddin
authors.forename: Bilal
authors.initials: B
authors.lastname: Mahmood
authors.forename: Ariel
authors.initials: A
authors.lastname: Mueller
authors.forename: Brett A
authors.initials: BA
authors.lastname: Simon
authors.forename: Victor
authors.initials: V
authors.lastname: Novack
authors.forename: Daniel
authors.initials: D
authors.lastname: Talmor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000000981:diagnostic imaging* / Q000453:epidemiology*