The Utility Of Tissue Doppler Imaging To Assess Ventricular Function In Patients With Sepsis: A Clinical Study

Aim: To monitor the cardiac ventricular function in control group and in patients with sepsis and septic shock by using traditional two-dimensional echocardiography and tissue Doppler image(TDI),and to investigate the feasibility of TDI in the early detection of septic myocardial injury.Methods: The subjects were divided into healthy control group(n=40),sepsis group(n=40)and septic shock group(n=30).Within 24 hours of admission,the examination of subjects by traditional two-dimensional echocardiography and TDI.First,following indexes were tested by traditional two-dimensional echocardiography: left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(Ejection,fraction,EF),early diastolic mitral blood flow peak velocity(E2),late diastolic mitral blood peak velocity(A2),and calculate the E2/A2,right ventricular end diastolic diameter(RVd),right ventricular end systolic diameter(RVs),early diastolic tricuspid annular blood flow maximum velocity(E3),late diastolic tricuspid annular blood flow peak velocity(A3),and calculate the E3/A3.Second,aftertraditional two-dimensional echocardiography examination,by tissue Doppler imaging measurement,systolic mitral anterior lobe annular peak velocity(Sm),early diastolic peak velocity(Em),late diastolic peak velocity(Am),isovolumic contraction time(ICT),isovolumic relaxation time(IRT)and ejection time(ET),and left ventricular myocardial performance index(LVMPI),LVMPI =(ICT+IRT)/ET;measurement of tricuspid annular systolic peak velocity(s'),early diastolic peak velocity(e'),late diastolic peak velocity(a'),ICT,IRT and ET,and calculate the right ventricular myocardial performance index RVMPI =(ICT+IRT)/ET.Observe and compare the change of cardiac function parameter in control group,sepsis group and septic shock group by using conventional two-dimensional ultrasound and tissue Doppler imaging.Results: 1.Traditional transthoracic two-dimensional ultrasound monitoring the change of cardic function parameter in the control group,sepsis and septic shock The LVEDD,LVESD,LVEF,RVs,RVd were not significantly different between the control group(n=40,44.5±4.3mm,32.7±4.9mm,64.6±5.6,28.0±6.5mm,35.1±6.2mm),sepsis(n=40,49.6±8.7mm,34.3±9.8mm,56.7±12.2,26.2±7.0mm,33.3±7.3mm)and septic shock group(n=30,46.1±9.3mm,30.0±7.9mm,60.3±10.0,29.7±5.2mm,27.4±5.1mm),P >0.05.The E2/A2 in the septic shock group(n=30,0.7±0.4)was significantly less than in sepsis group(n=40,0.9±0.3),P<0.05.E2/A2 in the sepsis group(n=40,0.9±0.3)was significantly lower than in the control group(n=40,1.2±0.4),P<0.05.The E3/A3 in the sepsis group(n=40,0.8±0.6)and septic shock group(n=30,0.6±0.80)was significantly lower than in the control group(n=40,1.3±0.7)P <0.05.2.TDI monitoring the change of cardic function parameter in the control group,sepsis and septic shock The Am,E/Em,e',a',E/e'were not significantly different between the control group(n=40,9.7±1.8cm/s,6.3±2.5,10.8±2.4 cm/s,13.6±4.2 cm/s,7.5±1.9),sepsis group(n=40,7.2±2.4cm/s,9.3±3.7,10.5±3.2 cm/s,12.5±4.0 cm/s,8.2±2.5)and septic shock group(n=30,8.4±1.6 cm/s,10.6±4.6,9.5±4.3 cm/s,9.1±3.6 cm/s,8.6±3.1),P >0.05.Sm,s',Em/Am,e'/ a'in septic shock group(n=30,6.8±4.2 cm/s,8.3±4.2 cm/s,0.6±0.3,0.7±0.6)were significantly less than those in sepsis group(n=40,11.6±1.9 cm/s,12.1±4.8 cm/s,0.8±0.2,0.9±0.8),P<0.05.Sm,s',Em/Am,e'/ a' in the sepsis group(n=40,11.6±1.9 cm/s,12.1±4.8 cm/s,0.8±0.2,0.9±0.8)were significantly lower than that in the control group(n=40,13.5±1.7 cm/s,14.9±3.1 cm/s,1.1±0.4,1.1±0.5),P<0.05.LVMPI in septic shock group(n=30,0.59 + 0.26)was significantly higher than in sepsis group(n=40,0.46+ 0.19),P<0.05.LVMPI in sepsis group(n=40,0.46 + 0.19)was significantly more than in the control group(n=40,0.39 + 0.23),P<0.05.RVMPI in sepsis group(n=40,0.58 + 0.12)and septic shock group(n=30,0.56 + 0.16)were statistically higher than in the normal control group(n=40,0.46 + 0.04),P<0.05.The Em in sepsis group(n=40,8.1±2.6 cm/s)and septic shock group(n=30,8.1±2.4 cm/s)were statistically lower than in the normal control group(n=40,10.6±2.7 cm/s),P <0.05.Conclusion: First,according to the traditional two-dimensional ultrasound,the LVEF was not significantly different in in three groups.Second,TDI parameters took advantage of description the strength of the myocardial contraction,Such as Sm,s' were significantly different in sepsis and septic shock compared with control group.Third,The change in early diastolic function of sepsis can be detected by Traditional two-dimensional ultrasound and TDI.Finally,TDI has the advantages of finding early change of systolic and diastolic function in patients with sepsis,which has very potential important clinical value and needs more clinical investigation.