There is no formal diagnostic criterion for sepsis-induced cardiomyopathy (SICM), but left ventricular ejection fraction (LVEF) < 50% was the most commonly used standard. Tissue motion annular displacement (TMAD) is a novel speckle tracking indicator to quickly assess LV longitudinal systolic function. This study aimed to evaluate the feasibility and discriminatory value of TMAD for predicting SICM, as well as prognostic value of TMAD for mortality. We conducted a single-center retrospective observational study in patients with sepsis or septic shock who underwent echocardiography examination within the first 24 h after admission. Basic clinical information and conventional echocardiographic data, including mitral annular plane systolic excursion (MAPSE), were collected. Based on speckle tracking echocardiography (STE), global longitudinal strain (GLS) and TMAD were, respectively, performed offline. The parameters acquisition rate, inter- and intra-observer reliability, time consumed for measurement were assessed for the feasibility analysis. Areas under the receiver operating characteristic curves (AUROC) values were calculated to assess the discriminatory value of TMAD/GLS/MAPSE for predicting SICM, defined as LVEF < 50%. Kaplan–Meier survival curve analysis was performed according to the cutoff values in predicting SICM. Cox proportional hazards model was performed to determine the risk factors for 28d and in-hospital mortality. A total of 143 patients were enrolled in this study. Compared with LVEF, GLS or MAPSE, TMAD exhibited the highest parameter acquisition rate, intra- and inter-observer reliability. The mean time for offline analyses with TMAD was significantly shorter than that with LVEF or GLS (p < 0.05). According to the AUROC analysis, TMADMid presented an excellent discriminatory value for predicting SICM (AUROC > 0.9). Patients with lower TMADMid (< 9.75 mm) had significantly higher 28d and in-hospital mortality (both p < 0.05). The multivariate Cox proportional hazards model revealed that BMI and SOFA were the independent risk factors for 28d and in-hospital mortality in sepsis cases, but TMAD was not. STE-based TMAD is a novel and feasible technology with promising discriminatory value for predicting SICM with LVEF < 50%.

中文翻译：

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脓毒症心肌病组织运动环状位移的可行性和鉴别价值：一项单中心回顾性观察研究

脓毒症诱发的心肌病 (SICM) 没有正式的诊断标准，但左心室射血分数 (LVEF) < 50% 是最常用的标准。组织运动环状位移 (TMAD) 是一种新颖的散斑跟踪指标，可快速评估 LV 纵向收缩功能。本研究旨在评估 TMAD 预测 SICM 的可行性和判别价值，以及 TMAD 对死亡率的预后价值。我们对入院后 24 小时内接受超声心动图检查的脓毒症或感染性休克患者进行了一项单中心回顾性观察研究。收集基本临床信息和常规超声心动图数据，包括二尖瓣环平面收缩偏移 (MAPSE)。基于斑点追踪超声心动图（STE），全局纵向应变 (GLS) 和 TMAD 分别离线进行。对参数采集率、观察者间和观察者内的可靠性、测量所消耗的时间进行了评估，以进行可行性分析。计算接受者操作特征曲线 (AUROC) 值下的面积，以评估 TMAD/GLS/MAPSE 预测 SICM 的判别值，定义为 LVEF < 50%。根据预测 SICM 的截止值进行 Kaplan-Meier 生存曲线分析。采用 Cox 比例风险模型确定 28 天和住院死亡率的危险因素。共有 143 名患者参加了这项研究。与 LVEF、GLS 或 MAPSE 相比，TMAD 表现出最高的参数获取率、观察者内和观察者间的可靠性。TMAD 离线分析的平均时间明显短于 LVEF 或 GLS (p < 0.05)。根据 AUROC 分析，TMADMid 在预测 SICM（AUROC > 0.9）方面表现出极好的判别价值。TMADMid 较低（< 9.75 mm）的患者 28 天死亡率和住院死亡率显着升高（均 p < 0.05）。多变量 Cox 比例风险模型显示，BMI 和 SOFA 是脓毒症病例 28 天和院内死亡率的独立危险因素，但 TMAD 不是。基于 STE 的 TMAD 是一种新颖可行的技术，在预测 LVEF < 50% 的 SICM 方面具有良好的判别价值。TMADMid 较低（< 9.75 mm）的患者 28 天死亡率和住院死亡率显着升高（均 p < 0.05）。多变量 Cox 比例风险模型显示，BMI 和 SOFA 是脓毒症病例 28 天和院内死亡率的独立危险因素，但 TMAD 不是。基于 STE 的 TMAD 是一种新颖可行的技术，在预测 LVEF < 50% 的 SICM 方面具有良好的判别价值。TMADMid 较低（< 9.75 mm）的患者 28 天死亡率和住院死亡率显着升高（均 p < 0.05）。多变量 Cox 比例风险模型显示，BMI 和 SOFA 是脓毒症病例 28 天和院内死亡率的独立危险因素，但 TMAD 不是。基于 STE 的 TMAD 是一种新颖可行的技术，在预测 LVEF < 50% 的 SICM 方面具有良好的判别价值。