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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2017

Open Access 01-12-2017 | Research

Associations among left ventricular systolic function, tachycardia, and cardiac preload in septic patients

Authors: Michael J. Lanspa, Sajid Shahul, Andrew Hersh, Emily L. Wilson, Troy D. Olsen, Eliotte L. Hirshberg, Colin K. Grissom, Samuel M. Brown

Published in: Annals of Intensive Care | Issue 1/2017

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Abstract

Background

In sepsis, tachycardia may indicate low preload, adrenergic stimulation, or both. Adrenergic overstimulation is associated with septic cardiomyopathy. We sought to determine whether tachycardia was associated with left ventricular longitudinal strain, a measure of cardiac dysfunction. We hypothesized an association would primarily exist in patients with high preload.

Methods

We prospectively observed septic patients admitted to three study ICUs, who underwent early transthoracic echocardiography. We measured longitudinal strain using speckle tracking echocardiography and estimated preload status with an echocardiographic surrogate (E/e′). We assessed correlation between strain and heart rate in patients with low preload (E/e′ < 8), intermediate preload (E/e′ 8–14), and high preload (E/e′ > 14), adjusting for disease severity and vasopressor dependence.

Results

We studied 452 patients, of whom 298 had both measurable strain and preload. Abnormal strain (defined as >−17%) was present in 54%. Patients with abnormal strain had higher heart rates (100 vs. 93 beat/min, p = 0.001). After adjusting for vasopressor dependence, disease severity, and cardiac preload, we observed an association between heart rate and longitudinal strain (β = 0.05, p = 0.003). This association persisted among patients with high preload (β = 0.07, p = 0.016) and in patients with shock (β = 0.07, p = 0.01), but was absent in patients with low or intermediate preload and those not in shock.

Conclusions

Tachycardia is associated with abnormal left ventricular strain in septic patients with high preload. This association was not apparent in patients with low or intermediate preload.
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Metadata
Title
Associations among left ventricular systolic function, tachycardia, and cardiac preload in septic patients
Authors
Michael J. Lanspa
Sajid Shahul
Andrew Hersh
Emily L. Wilson
Troy D. Olsen
Eliotte L. Hirshberg
Colin K. Grissom
Samuel M. Brown
Publication date
01-12-2017
Publisher
Springer Paris
Published in
Annals of Intensive Care / Issue 1/2017
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-017-0240-2

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