• Kei Sato, Karin Wildi, Jonathan Chan, Chiara Palmieri, Nchafatso G Obonyo, Silver Heinsar, Keibun Liu, Samantha Livingstone, Noriko Sato, Carmen Ainola, Gabriella Abbate, Mahé Bouquet, Emily Wilson, Margaret Passmore, Kieran Hyslop, David G Platts, Jacky Suen, BassiGianluigi LiGLCritical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia., and John F Fraser.
• Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.
• Eur. J. Clin. Invest. 2024 Feb 1; 54 (2): e14106e14106.

BackgroundLeft ventricular stroke work index (LVSWI) and afterload-related cardiac performance (ACP) consider left ventricular (LV) afterload and could be better prognosticators in septic cardiomyopathy. However, their invasive nature prevents their routine clinical applications. This study aimed to investigate (1) whether a proposed speckle-tracking echocardiography parameter, Pressure-Strain Product (PSP), can non-invasively predict catheter-based LVSWI, ACP and serum lactate in an ovine model of septic cardiomyopathy; and (2) whether PSP can distinguish the sub-phenotypes of acute respiratory distress syndrome (ARDS) with or without sepsis-like conditions.MethodsSixteen sheep with ARDS were randomly assigned to either (1) sepsis-like (n = 8) or (2) non-sepsis-like (n = 8) group. Each ARDS and sepsis-like condition was induced by intravenous infusion of oleic acid and lipopolysaccharide, respectively. Pulmonary artery catheter-based LVSWI (the product of stroke work index, mean arterial pressure and .0136), ACP (the percentage of cardiac output measured to cardiac output predicted as normal) and serum lactate were measured simultaneously with transthoracic echocardiography. Two PSP indices were calculated by multiplying the mean arterial blood pressure and either global circumferential strain (PSPcirc) or radial strain (PSPrad).ResultsPSPcirc showed a significant correlation with LVSWI (r2  = .66, p < .001) and ACP (r2  = .82, p < .001) in the sepsis-like group. Although PSP could not distinguish subphenotypes, PSPcirc predicted LVSWI (AUC .86) and ACP (AUC .88), and PSPrad predicted serum lactate (AUC .75) better than LV ejection fraction, global circumferential and radial strain.ConclusionsA novel PSP has the potential to non-invasively predict catheter-based LVSWI and ACP, and was associated with serum lactate in septic cardiomyopathy.© 2023 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.

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