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Mortality in patients with septic cardiomyopathy identified by longitudinal strain by speckle tracking echocardiography: An updated systematic review and meta-analysis with trial sequential analysis.
Pruszczyk, Andrzej; Zawadka, Mateusz; Andruszkiewicz, Pawel; LaVia, Luigi; Herpain, Antoine; Sato, Ryota; Dugar, Siddharth; Chew, Michelle S; Sanfilippo, Filippo.
Afiliação
  • Pruszczyk A; 2nd Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Poland.
  • Zawadka M; 2nd Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Poland.
  • Andruszkiewicz P; 2nd Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Poland.
  • LaVia L; Department of Anesthesia and Intensive Care, "Policlinico-San Marco" University Hospital, Catania, Italy.
  • Herpain A; Department of Intensive Care, St.-Pierre University Hospital, Université Libre de Bruxelles, 1050 Brussels, Belgium; Experimental Laboratory of Intensive Care, Université Libre de Bruxelles, 1050 Brussels, Belgium.
  • Sato R; Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States.
  • Dugar S; Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States.
  • Chew MS; Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
  • Sanfilippo F; Department of Anesthesia and Intensive Care, "Policlinico-San Marco" University Hospital, Catania, Italy; Department of General Surgery and Medico-Surgical Specialties, School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy. Electronic address: filipposanfi@yahoo.it.
Anaesth Crit Care Pain Med ; 43(2): 101339, 2024 Apr.
Article em En | MEDLINE | ID: mdl-38128732
ABSTRACT

BACKGROUND:

Septic cardiomyopathy is associated with poor outcomes but its definition remains unclear. In a previous meta-analysis, left ventricular (LV) longitudinal strain (LS) showed significant prognostic value in septic patients, but findings were not robust due to a limited number of studies, differences in effect size and no adjustment for confounders.

METHODS:

We conducted an updated systematic review (PubMed and Scopus up to 14.02.2023) and meta-analysis to investigate the association between LS and survival in septic patients. We included studies reporting global (from three apical views) or regional LS (one or two apical windows). A secondary analysis evaluated the association between LV ejection fraction (EF) and survival using data from the selected studies.

RESULTS:

We included fourteen studies (1678 patients, survival 69.6%) and demonstrated an association between better performance (more negative LS) and survival with a mean difference (MD) of -1.45%[-2.10, -0.80] (p < 0.0001;I2 = 42%). No subgroup differences were found stratifying studies according to number of views used to calculate LS (p = 0.31;I2 = 16%), severity of sepsis (p = 0.42;I2 = 0%), and sepsis criteria (p = 0.59;I2 = 0%). Trial sequential analysis and sensitivity analyses confirmed the primary findings. Grade of evidence was low. In the included studies, thirteen reported LVEF and we found an association between higher LVEF and survival (MD = 2.44% [0.44,4.45]; p = 0.02;I2 = 42%).

CONCLUSIONS:

We confirmed that more negative LS values are associated with higher survival in septic patients. The clinical relevance of this difference and whether the use of LS may improve understanding of septic cardiomyopathy and prognostication deserve further investigation. The association found between LVEF and survival is of unlikely clinical meaning. REGISTRATION PROSPERO number CRD42023432354.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Ecocardiografia / Sepse / Cardiomiopatias Tipo de estudo: Systematic_reviews Limite: Humans Idioma: En Revista: Anaesth Crit Care Pain Med Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Polônia

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Ecocardiografia / Sepse / Cardiomiopatias Tipo de estudo: Systematic_reviews Limite: Humans Idioma: En Revista: Anaesth Crit Care Pain Med Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Polônia