et al. Ann. Intensive Care (2018) 8:29
Use of speckle-tracking strain
in preload-dependent patients, need
for cautious interpretation!
, M. Gardette
, M. Leone
, L. Reydellet
, V. Blasco
, A. Lannelongue
, F. Sayagh
, S. Wiramus
, J. Albanèse
and L. Zieleskiewicz
Background: In critical patients, left ventricular ejection fraction and fractional shortening are used to reﬂect left
ventricular systolic function. An emerging technique, two-dimensional-strain echocardiography, allows assessment
of the left ventricle systolic longitudinal deformation (global longitudinal strain) and the speed at which this deforma-
tion occurs (systolic strain rate). This technique is of increasing use in critical patients in intensive care units and in the
peri-operative period where preload constantly varies. Our objective, in this prospective single-center observational
study, was to evaluate the eﬀect of ﬂuid resuscitation on two-dimensional-strain echocardiography measurements in
preload-dependent critically ill patients. We included 49 patients with preload dependence attested by an increase of
at least 10% in the left ventricular outﬂow track velocity–time integral measured by echocardiography during a pas-
sive leg raising maneuver. Echocardiography was performed before ﬂuid resuscitation (echocardiography 1) and after
preload independency achievement (echocardiography 2).
Results: Two-dimensional-strain echocardiography was feasible in 40 (82%) among the 49 patients. With preload
dependence correction, the absolute value of global longitudinal strain and systolic strain rate was signiﬁcantly
increased from, respectively, − 13.3 ± 3.5 to − 18.4% ± 4.5 (p < 0.01) and − 1.11 s
± 0.29 to − 1.55 s
(p < 0.001). The ﬂuid resuscitation aﬀects GLS and SSR in preload-dependent patients, with a shift, for GLS, from
pathological to normal values.
Conclusion: In critically ill patients, the assessment of the systolic function by two-dimensional-strain echocardi-
ography needs prior evaluation of preload dependency, in order to adequately interpret this variable. Future studies
should assess the ability of global longitudinal strain to guide ﬂuid management in the critically ill patients.
Keywords: Preload dependence, Fluid responsiveness, Passive leg raising, 2D-strain echocardiography, Speckle
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Systolic function assessment is crucial in the manage-
ment of the critically ill patient. Using conventional echo-
cardiography, left ventricular ejection fraction (LV EF)
and fractional shortening are routinely used . How
ever, these variables depend on preload and afterload
conditions . ey can be diﬃcult to interpret in unsta
ble patients such as those in septic shock .
Strain echocardiography (2D-strain) is a noninvasive
ultrasound imaging technique that allows for an objec
tive and quantitative evaluation of myocardial function.
It measures the percentage of deformation of the left
ventricle (LV) during systole (systolic strain) and the
speed at which this deformation occurs (strain rate) [4,
5]. is technique has been validated after comparison
with reference techniques: magnetic resonance imag
ing and sonomicrometry [5, 6]. e American Society
C. Nafati and M. Gardette are joint ﬁrst authors and contributed equally
Service d’anesthésie et de réanimation, CHU de la Timone, 264 rue Saint
Pierre, 13005 Marseille, France
Full list of author information is available at the end of the article