Clinical trial NCT03702569: Speckle-Tracking and Volume Expansion
Official title: Myocardial Effects of Volume Expansion Evaluated Using Speckle-Tracking (STRAIN) in Intensive Care Unit Patients
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Volume Expansion
Left Ventricular Contractility
Keywords: Volume Expansion
Intensive Care Unit
Left Ventricular Contractility
Speckle Tracking
STRAIN
Lead sponsor: University Hospital, Bordeaux
Sponsor class: OTHER
First posted: 2018-10-11
Enrollment: 77
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_ONLY
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patient older than 18 years hospitalized in neuro-intensive care unit of Bordeaux University Hospital needing volume expansion.

Brief summary: Volume expansion is the cornerstone of hemodynamic management of patients suffering from circulatory failure. The main objective of volume expansion is to increase stroke volume. This increase in stroke volume is due to myocardial contractility improvement. Nowadays, this improvement cannot be assessed using classical monitoring used at the bedside. The main objective of this study is to evaluate left ventricular contractility using Speckle-Tracking before and after volume expansion in intensive care unit patients, to determine if this technology is more sensitive than previous for left ventricular contractility assessment.

Detailed description: The main objective of volume expansion is to increase stroke volume. Frank-Starling curve is schematically divided into two portions: a vertical portion which mean that an increase in preload secondary to volume expansion will induce an increase in stroke volume; and a flat portion which mean that a same increase in preload will not induce an increase in stroke volume. Stroke volume increase is due to a myocardial contractility improvement. Nowadays this improvement cannot be assessed using classical monitoring used at the bedside (left ventricular ejection fraction, fractional area changes, etc ...). A new method is available to assess left ventricular contractility at the bedside. Two-dimensional speckle tracking images with echocardiography allows one to track a natural myocardial marker within the myocardium by standard transthoracic echocardiography. It provides unique insights into myocardial function such as tissue deformations and strain rate, which is the rate of deformation. This method is more sensitive than classical echographic left ventricular ejection fraction evaluation. Few data are available about the potential interest of speckle tracking to track an improvement of left ventricular contractility following a volume expansion in intensive care unit patients.

This study is observational, prospective in one center. Patients needing a volume expansion will benefit from an echocardiography (stroke volume and longitudinal strain assessment) before and after fluid challenge (500mL of crystalloids).

The follow up will be restricted to the duration of volume expansion. The last data will be collected just after the end of volume expansion.

Eligibility criteria: Inclusion Criteria:

* patient older than 18 years
* hospitalized in neuro-intensive care unit
* volume expansion indicated by the physician
* indication of a transthoracic echocardiography

Exclusion Criteria:

* low echogenicity

Primary outcomes:
measure: Left ventricular Global Longitudinal Strain
timeFrame: 3 minutes before the beginning of volume expansion of 500ml of crystalloid
measure: Left ventricular Global Longitudinal Strain
timeFrame: 3 minutes after the beginning of volume expansion of 500ml of crystalloid
measure: Stroke volume
timeFrame: 3 minutes before the beginning of volume expansion of 500ml of crystalloid
measure: Stroke volume
timeFrame: 3 minutes after the beginning of volume expansion of 500ml of crystalloid
Secondary outcomes:
Other outcomes:
Locations:
city: Bordeaux
country: France
facility: CHU de Bordeaux
Study officials:
References: