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Table 1 Summary of echocardiographic variables that have been used to evaluate septic cardiomyopathy

From: Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: a review of the literature

  Echo parameter Measurement Significant findings Strengths Limitations Comments
Left ventricle       
Systolic EF EF = (LVEDV − LVESV)/LVEDV × 100 Abnormal LV systolic function suggested by EF < 52% in men or < 54% in women [63] Frequently used; easy to acquire Biplane Simpson’s Method of Discs is the only currently recognized method per ASE guidelines. Requires adequate image quality; EF will vary with beat to beat variation; highly dependent on loading conditions of the LV Familiar to all clinicians. Fails to accurately identify all patients with SC
GLS GLS (%) = (MLs − MLd)/MLd Abnormal LV systolic function suggested by peak GLS < − 20% [63] Improved prognostication over LVEF for determining LV systolic function; independent of angle Requires adequate image quality, absence of foreshortening, and three standard apical views. No consensus on abnormal values due to variability in vendors and analytic software Speckle-tracking technology increasingly available
Systolic mitral annular velocity (S′) AVG peak systolic velocity (cm/s) of the mitral annulus is measured using spectral TDI No current consensus recommendations on abnormal values; abnormal LV systolic function suggested by decreased S′ < 10 cm/s Easy to acquire; less dependent on preload Not well validated; heterogeneity of values depending on patient age; may be affected by regional wall motion abnormalities, annular calcifications, and prosthetic valves Able to be performed with old or modern equipment
MAPSE MAX systolic plane excursion of the lateral mitral annulus (cm) is measured using M-mode No current consensus recommendations on abnormal values; abnormal LV systolic function suggested by decreased MAPSE < 1 cm Easy to acquire Requires adequate M-mode cross section; may be affected by regional wall motion abnormalities, annular calcifications, and prosthetic valves Conceptually similar to GLS, but able to be performed without speckle-tracking or Doppler
MPI MPI = (TST − ET)/ET Abnormal LV function suggested by MPI > 0.40 [78] Derived from simple time interval recordings; less load dependency; does not rely on geometric assumptions Limited validated research; both systolic and diastolic dysfunction can result in an abnormal MPI; requires accurate measurements of cardiac time intervals Most clinicians have little familiarity with this measure
Diastolica e’ Peak e’ velocity (cm/s) in early diastole measured using PW Doppler at lateral and septal basal regions and then averaged Abnormal LV diastolic function suggested by e’ (septum) < 7 cm/s or e’ (lateral) < 10 cm/s [51] Easy to acquire; less dependent on preload Regional wall motion abnormalities and CAD will affect the measurement; heterogeneity of values depending on patient age Highly studied and shows promise as a simplified method of assessing diastolic function in SC
E/e’ E/e’ = E (cm/s)/e’ (cm/s) Abnormal LV diastolic function suggested by average E/e’ > 14 cm/s [51] Easy to acquire Regional wall motion abnormalities and CAD will affect the measurement; limited accuracy in normal patients, or patients with annular calcification, mitral valve or pericardial disease; heterogeneity of values depending on patient age Similar potential as e’; allows estimation of pulmonary capillary wedge pressure via formula: E/e’ + 4.6
Right ventricle       
Systolic TAPSE MAX plane of systolic excursion of the lateral tricuspid annulus (mm) is measured using M-mode Abnormal RV systolic function suggested by TAPSE < 17 mm [63]. Easy to acquire; well demonstrated prognostic value Only evaluates longitudinal myocardial shortening; dependent on angle; may be affected by LV systolic dysfunction and significant tricuspid regurgitation Important associations with mortality [64]
  1. ASE American Society of Echocardiography, AVG average, CAD coronary artery disease, EF ejection fraction, ET ejection time, GLS global longitudinal strain, LVEDV left ventricular end diastolic volume, LVEF left ventricular ejection fraction, LVESV left ventricular end systolic volume, MAPSE mitral annular plane of systolic excursion, MAX maximum, MLd myocardial length end-diastole, MLs myocardial length end-systole, MPI myocardial performance index, PW pulsed wave, TAPSE tricuspid annular plane of systolic excursion, TDI tissue Doppler imaging, TST total systolic time
  2. a The table provides general guidelines for annular velocities and ratios based on the 2016 recommendations for the evaluation of left ventricular diastolic function. Based on these recommendations, there are four recommended variables and abnormal values for determining diastolic dysfunction: septal e’ < 7 cm/s, lateral e’ < 10 cm/s, average E/e’ ratio > 14, LA volume index > 34 mL/m2, and peak TR velocity > 2.8 m/s. Left ventricular diastolic function is considered abnormal if more than half of these variables exceed their cutoff values. The 2009 recommendations for the evaluation of left ventricular diastolic function previously suggested an abnormal septal e’ < 8 cm/s and lateral e’ < 10 cm/s. Existing studies have relied upon a simplified version of the 2009 ASE guidelines for assessing diastolic function (using only e’ and E/e’); while one study [60] found that measures beyond e’ and E/e’ provided limited additional prognostic information, whether application of the updated guidelines would improve the prognostic utility of diastolic assessment requires further study