The assessment of left ventricular function in septic shock; comparison of ejection fraction measurement (both by two dimensional and three dimensional echocardiography), Global Longitudinal Strain, high sensitivity Troponin and Pro NtBNP.
Portsmouth Hospital NHS Trust
researchregistry5412, Research registry; clinical trails, will be registered post ethical approval
Duration of Study in the UK
3 years, 0 months, 1 days
Cardiac ultrasound (echocardiography) is performed on patients with sepsis and septic shock on the intensive care unit (ICU) to assess function of the left ventricle (LV) of the heart. In septic shock the LV begins to fail and does not pump efficiently. This failure leads to reduced organ perfusion and is a major contributor to mortality. Prompt identification of LV failure allows clinicians to make choices regarding medical therapy aimed at preventing the multi organ failure associated with LV failure in septic shock.
The current method of assessing LV function using echocardiography is two dimensional (2D) assessment of function. However this is documented as prone to inaccuracy both at point of acquisition and analysis. The acknowledged 'gold standard' for assessing LV function is magnetic resonance imaging (MRI) which is not feasible in the ICU population.
Alternative methods of LV assessment using advanced echocardiography techniques such as three dimensional (3D) assessment & Global Longitudinal Strain (GLS), offer detailed LV analysis but do not currently form part of routine LV assessment. Past studies show that GLS is an earlier marker of LV failure than 2D imaging, and 3D assessment is closely matched with the accuracy of MRI.
Blood markers are routinely used in detecting LV failure in other patient groups, but are not used in sepsis or septic shock. It is unknown if these add clinical information. Furthermore, LV function of survivors has never been assessed beyond the hospitalisation stage and no data exists investigating the legacy of LV failure in septic shock.
It is unknown if: a) GLS and 3D echo alone or in combination with blood markers identifies LV failure earlier than 2D echo in septic shock patients, and b) any echo method alone or combined with blood markers can predict those who may develop LV failure in the year after diagnosis.
East of England - Cambridge Central Research Ethics Committee
Date of REC Opinion
13 Oct 2020
Further Information Favourable Opinion