正木 充¹, PULIDO Juan², 湯浅 敏典⁴, GILLESPIE Shane², AFESSA Bekele³, BROWN Daniel², MANKAD Sunil¹, OH Jae¹

Mitsuru MASAKI¹, Juan PULIDO², Toshinori YUASA⁴, Shane GILLESPIE², Bekele AFESSA³, Daniel BROWN², Sunil MANKAD¹, Jae OH¹

¹Mayo Clinic　Department of Cardiovascular disease, ²Mayo Clinic　Department of Anesthesia and Critical Care Medicine, ³Mayo Clinic　Department Pulmonary and Critical Care, ⁴鹿児島大学循環器 呼吸器 代謝内科学

¹Department of Cardiovascular disease, Mayo Clinic, ²Department of Anesthesia and Critical Care Medicine, Mayo Clinic, ³Department Pulmonary and Critical Care, Mayo Clinic, ⁴Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduated School of Medicine, Kagoshima University

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【Background】
The aim of the present study was to investigate the Left ventricular （LV） myocardial deformation properties using speckle tracking echocardiography （STE） in patients with severe sepsis or septic shock and evaluate potential prognostic implications.
【Methods】
Forty patients admitted to the intensive care unit （ICU） with severe sepsis or septic shock with preserved LV ejection fraction （LVEF） were prospectively enrolled. LV function by STE was performed within 24 hours of admission to the ICU. Study patients were divided into 2 groups: survival group （Ages 69 ±12，n＝26）, non-survival （Day 30 Mortality） group （Ages 70 ± 14，n＝14）. We measured STE profiles at the basal, mid- and apical portions of the LV septal wall in the apical four chamber view.
【Results】
There was no difference in age, heart rate, LVEF, vasoactive medication and transmitral early diastolic flow between survival group and non-survival group. LV end diastolic volume was lower in survival group than in non-survival. The peak systolic strain in the average of all 3 septal strain measurements were lower in survival group than in non-survival group （survival group vs. non-survival group; -17.0 ± 4.5 ％ vs. -23.0 ± 4.7 ％，p＜0.001）. Hemoglobin concentration was higher in survival group than in non-survival group （p＜0.01）. Moreover, LV strain mean was positively related to Hemoglobin （r＝0.39，P＜0.05）.
【Conclusions】
These results suggest that patients presenting with severe sepsis or septic shock that died and had preserved LVEF on admission, had higher LV systolic strain, dilated LV volume and lower Hemoglobin compared to the patients that survived. Evaluation of the LV longitudinal contraction by STE may serve as useful tool to predict survival in this patient population.