A novel speckle-tracking echocardiography parameter assessing left ventricular afterload

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Sato, Kei
Wildi, Karin
Chan, Jonathan
Palmieri, Chiara
Obonyo, Nchafatso G
Heinsar, Silver
Liu, Keibun
Livingstone, Samantha
Sato, Noriko
Ainola, Carmen
Abbate, Gabriella
Bouquet, Mahé
Wilson, Emily
Passmore, Margaret
Hyslop, Kieran
et al.
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BACKGROUND: Left ventricular stroke work index (LVSWI) and afterload-related cardiac performance (ACP) consider left ventricular (LV) afterload and could be better prognosticators in septic cardiomyopathy. However, their invasive nature prevents their routine clinical applications. This study aimed to investigate (1) whether a proposed speckle-tracking echocardiography parameter, Pressure-Strain Product (PSP), can non-invasively predict catheter-based LVSWI, ACP and serum lactate in an ovine model of septic cardiomyopathy; and (2) whether PSP can distinguish the sub-phenotypes of acute respiratory distress syndrome (ARDS) with or without sepsis-like conditions. METHODS: Sixteen sheep with ARDS were randomly assigned to either (1) sepsis-like (n = 8) or (2) non-sepsis-like (n = 8) group. Each ARDS and sepsis-like condition was induced by intravenous infusion of oleic acid and lipopolysaccharide, respectively. Pulmonary artery catheter-based LVSWI (the product of stroke work index, mean arterial pressure and .0136), ACP (the percentage of cardiac output measured to cardiac output predicted as normal) and serum lactate were measured simultaneously with transthoracic echocardiography. Two PSP indices were calculated by multiplying the mean arterial blood pressure and either global circumferential strain (PSPcirc) or radial strain (PSPrad). RESULTS: PSPcirc showed a significant correlation with LVSWI (r2  = .66, p < .001) and ACP (r2  = .82, p < .001) in the sepsis-like group. Although PSP could not distinguish subphenotypes, PSPcirc predicted LVSWI (AUC .86) and ACP (AUC .88), and PSPrad predicted serum lactate (AUC .75) better than LV ejection fraction, global circumferential and radial strain. CONCLUSIONS: A novel PSP has the potential to non-invasively predict catheter-based LVSWI and ACP, and was associated with serum lactate in septic cardiomyopathy.

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European Journal of Clinical Investigation
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© 2023 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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Cardiology (incl. cardiovascular diseases)
Cardiovascular medicine and haematology
Clinical sciences
afterload-related cardiac performance
left ventricular stroke work index
septic cardiomyopathy
speckle-tracking echocardiography
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Sato, K; Wildi, K; Chan, J; Palmieri, C; Obonyo, NG; Heinsar, S; Liu, K; Livingstone, S; Sato, N; Ainola, C; Abbate, G; Bouquet, M; Wilson, E; Passmore, M; Hyslop, K; Platts, DG; Suen, J; Bassi, GL; Fraser, JF, A novel speckle-tracking echocardiography parameter assessing left ventricular afterload, European Journal of Clinical Investigation, 2023, pp. e14106