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Abstract：
BACKGROUND: Owing to a lack of data, this study aimed to explore the effect of cardiac preload on myocardial strain in patients with sepsis.
METHODS: A total of 70 patients with sepsis in intensive care unit (ICU) of a tertiary teaching hospital in China from January 2018 to July 2019 and underwent transthoracic echocardiography were enrolled. Echocardiographic data were recorded at ICU admission and 24 h later. Patients were assigned to low left ventricular end-diastolic volume index (LVEDVI) and normal LVEDVI groups. We assessed the impact of preload on myocardial strain between the groups and analyzed the correlation of echocardiographic parameters under different preload conditions.
RESULTS: Thirty-seven patients (53%) had a low LVEDVI and 33 (47%) a normal LVEDVI. Those in the low LVEDVI group had a faster heart rate (121.7 vs. 95.3, p < 0.001) and required a greater degree of fluid infusion (3.67 L vs. 2.62 L, P = 0.019). The left ventricular global strain (LVGLS) (-8.60% vs. -10.80%, p = 0.001), left ventricular global circumferential strain (LVGCS) (-13.83% vs. -18.26%, p = 0.006), and right ventricular global longitudinal strain (RVGLS) (-6.9% vs. -10.60%, p = 0.001) showed significant improvements in the low LVEDVI group after fluid resuscitation. However, fluid resuscitation resulted in a significantly increased cardiac afterload value (1172.00 vs. 1487.00, p = 0.009) only in the normal LVEDVI group. Multivariate backward linear regression showed that LVEDVI changes were independently associated with myocardial strain-related improvements during fluid resuscitation. The baseline LVEDVI was significantly negatively correlated with the LVGLS and RVGLS (r = -0.44 and - 0.39, respectively) but not LVGCS. LVEDVI increases during fluid resuscitation were associated with improvements in the myocardial strain degree.
CONCLUSIONS: Myocardial strain alterations were significantly influenced by the cardiac preload during fluid resuscitation in sepsis.
METHODS: A total of 70 patients with sepsis in intensive care unit (ICU) of a tertiary teaching hospital in China from January 2018 to July 2019 and underwent transthoracic echocardiography were enrolled. Echocardiographic data were recorded at ICU admission and 24 h later. Patients were assigned to low left ventricular end-diastolic volume index (LVEDVI) and normal LVEDVI groups. We assessed the impact of preload on myocardial strain between the groups and analyzed the correlation of echocardiographic parameters under different preload conditions.
RESULTS: Thirty-seven patients (53%) had a low LVEDVI and 33 (47%) a normal LVEDVI. Those in the low LVEDVI group had a faster heart rate (121.7 vs. 95.3, p < 0.001) and required a greater degree of fluid infusion (3.67 L vs. 2.62 L, P = 0.019). The left ventricular global strain (LVGLS) (-8.60% vs. -10.80%, p = 0.001), left ventricular global circumferential strain (LVGCS) (-13.83% vs. -18.26%, p = 0.006), and right ventricular global longitudinal strain (RVGLS) (-6.9% vs. -10.60%, p = 0.001) showed significant improvements in the low LVEDVI group after fluid resuscitation. However, fluid resuscitation resulted in a significantly increased cardiac afterload value (1172.00 vs. 1487.00, p = 0.009) only in the normal LVEDVI group. Multivariate backward linear regression showed that LVEDVI changes were independently associated with myocardial strain-related improvements during fluid resuscitation. The baseline LVEDVI was significantly negatively correlated with the LVGLS and RVGLS (r = -0.44 and - 0.39, respectively) but not LVGCS. LVEDVI increases during fluid resuscitation were associated with improvements in the myocardial strain degree.
CONCLUSIONS: Myocardial strain alterations were significantly influenced by the cardiac preload during fluid resuscitation in sepsis.
摘要：
背景：由于缺乏数据，本研究旨在探讨心脏预负荷对脓毒症患者心肌劳损的影响。
方法：选取2018年1月至2019年7月在中国某三级教学医院重症监护病房(ICU)接受经胸超声心动图检查的70例脓毒症患者。在ICU入院时和24小时后记录超声心动图数据。患者分为左心室舒张末期容积指数（LVEDVI）低和LVEDVI正常组。我们评估了预负荷对组间心肌应变的影响，并分析了不同预负荷条件下超声心动图参数的相关性。
结果：37例患者（53%）LVEDVI低，33例（47%）LVEDVI正常。低LVEDVI组的心率较快（121.7vs.95.3，p<0.001），并且需要更大程度的输液（3.67Lvs.2.62L,P=0.019)。左心室整体应变(LVGLS)(-8.60%vs.-10.80%，p=0.001),左心室整体周向应变（LVGCS）（-13.83%vs.-18.26%,p=0.006),和右心室整体纵向应变（RVGLS）（-6.9％vs.-10.60%，p=0.001）显示液体复苏后低LVEDVI组的显着改善。然而,液体复苏导致心脏后负荷值显著增加(1172.00vs.1487.00，p=0.009）仅在正常LVEDVI组中。多元后向线性回归显示，LVEDVI变化与液体复苏过程中心肌劳损相关的改善独立相关。基线LVEDVI与LVGLS和RVGLS呈显著负相关（分别为r=-0.44和-0.39），但与LVGCS无关。液体复苏期间LVEDVI的增加与心肌应变程度的改善有关。
结论：脓毒症患者液体复苏过程中，心肌应变改变受心脏预负荷的显著影响。
方法：选取2018年1月至2019年7月在中国某三级教学医院重症监护病房(ICU)接受经胸超声心动图检查的70例脓毒症患者。在ICU入院时和24小时后记录超声心动图数据。患者分为左心室舒张末期容积指数（LVEDVI）低和LVEDVI正常组。我们评估了预负荷对组间心肌应变的影响，并分析了不同预负荷条件下超声心动图参数的相关性。
结果：37例患者（53%）LVEDVI低，33例（47%）LVEDVI正常。低LVEDVI组的心率较快（121.7vs.95.3，p<0.001），并且需要更大程度的输液（3.67Lvs.2.62L,P=0.019)。左心室整体应变(LVGLS)(-8.60%vs.-10.80%，p=0.001),左心室整体周向应变（LVGCS）（-13.83%vs.-18.26%,p=0.006),和右心室整体纵向应变（RVGLS）（-6.9％vs.-10.60%，p=0.001）显示液体复苏后低LVEDVI组的显着改善。然而,液体复苏导致心脏后负荷值显著增加(1172.00vs.1487.00，p=0.009）仅在正常LVEDVI组中。多元后向线性回归显示，LVEDVI变化与液体复苏过程中心肌劳损相关的改善独立相关。基线LVEDVI与LVGLS和RVGLS呈显著负相关（分别为r=-0.44和-0.39），但与LVGCS无关。液体复苏期间LVEDVI的增加与心肌应变程度的改善有关。
结论：脓毒症患者液体复苏过程中，心肌应变改变受心脏预负荷的显著影响。
