Strain Echocardiography Parameters Correlate With Disease Severity in Children and Infants With Sepsis
Bereketeab Haileselassie1, Erik Su, Iraklis Pozios
11Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD. 2Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD. 3Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Pediatric sepsis patients show reduced cardiac function on strain echocardiography, even with normal fractional shortening. This finding may help assess sepsis severity in children.
Area of Science:
- Cardiology
- Pediatric Critical Care
- Medical Imaging
Background:
- Sepsis-induced myocardial dysfunction is a critical factor in pediatric sepsis mortality.
- Traditional echocardiographic metrics like fractional shortening may not detect early cardiac dysfunction in pediatric sepsis.
- Strain echocardiography offers a more sensitive approach to assess cardiac function.
Purpose of the Study:
- To investigate the correlation between strain echocardiography metrics and illness severity in pediatric sepsis.
- To determine if strain echocardiography can identify myocardial dysfunction missed by fractional shortening in pediatric sepsis.
Main Methods:
- A retrospective observational study was conducted in a pediatric intensive care unit (PICU).
- Twenty-three pediatric patients admitted with sepsis underwent echocardiography.
- Strain echocardiography parameters were compared to internal controls and published normal values.
Main Results:
- Pediatric sepsis patients exhibited abnormal peak systolic longitudinal strain and low normal peak systolic circumferential strain compared to controls.
- Depressed strain parameters were observed despite normal fractional shortening in septic patients.
- Worsening longitudinal strain correlated with elevated lactate levels, an indicator of sepsis severity.
Conclusions:
- Strain echocardiography reveals depressed cardiac function in pediatric sepsis patients that is not apparent with fractional shortening.
- These findings suggest strain echocardiography's potential role in grading pediatric sepsis severity and guiding patient management.
Objectives:
In the progression of severe sepsis, sepsis-induced myocardial dysfunction contributes to severity of illness and ultimate mortality. Identification of sepsis-induced myocardial dysfunction causing depressed cardiac function during critical illness has implications for ongoing patient management. However, assessing pediatric cardiac function traditionally relies on echocardiographic qualitative assessment and measurement of left ventricular ejection fraction or fractional shortening. These metrics are often insensitive for detecting early or regional myocardial dysfunction. Strain echocardiography is a contemporary echocardiographic modality that may be more sensitive to perturbations in cardiac function. This investigation hypothesizes that strain echocardiography metrics correlate with severity of illness in pediatric sepsis despite normal fractional shortening.
Design:
Single-center retrospective observational study.
Setting:
Tertiary 36-bed medical/surgical PICU.
Patients:
Pediatric patients admitted with sepsis.
Interventions:
None.
Measurements And Main Results:
Twenty-three children with sepsis received an echocardiogram in the study period. Patients with sepsis demonstrated abnormal peak systolic longitudinal strain for age (mean = -0.13 ± 0.07; p < 0.01) and low normal peak systolic circumferential strain (mean = -0.17 ± 0.14; p = 0.02) compared with internal controls as well as previously published normal values. Depressed strain was demonstrated in the septic patients despite having normal fractional shortening (mean = 0.41; 95% CI, 0.38-0.43). On initial echocardiographic imaging, worsening peak systolic longitudinal strain was associated with increasing lactate (p = 0.04).
Conclusions:
Pediatric patients with sepsis demonstrate evidence of depressed strain echocardiography parameters not shown by fractional shortening that correlate with clinical indices of sepsis severity. Whether strain echocardiography could eventually assist in grading pediatric sepsis severity and affect management is an area for potential future investigation.
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