Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

Speckle-tracking analysis is a new available tool in order to assess left ventricular function in cardiology. Its noveltyrelies on the technological ability to track natural acoustic markers (known as speckle) within the myocardium duringthe cardiac cycle. This technology allows the evaluation of myocardium strain during systole and diastole. To date,global longitudinal strain (GLS) has been extensively studied in cardiology. It is now well established that GLS is moresensitive than left ventricular ejection fraction with 2D echocardiography in detecting systolic function impairment.It is also superior to left ventricular ejection fraction in the prediction of major cardio-vascular events. In the intensivecare unit (ICU) setting, data are scarce. In experimental model and human studies in septic shock, speckle-trackinganalysis suggests that GSL is impaired along with preserved left ventricular ejection fraction. Recent data also suggestthat GLS impairment could predict in-ICU mortality in septic shock. In severe subarachnoid haemorrhage patients,speckle-tracking analysis could be more sensitive in detecting stress cardiomyopathy. However, there are many gapsto fill in the critically ill patient. For instance, the influence of mechanical ventilation on GLS is not fully elucidated,and there are, to date, too few data to exactly assess potential GLS alterations on the patient’s outcome. Nonetheless,this new tool provides objective and sensitive data with acceptable intra and inter-observer variability and may beof primary interest in the evaluation of left-ventricular systolic function in the ICU.  Speckle-tracking analysis is a new available tool in order to assess left ventricular function in cardiology. Its novelty relies on the technological ability to track natural acoustic markers (known as speckle) within the myocardium during the cardiac cycle. This technology allows the evaluation of myocardium strain during systole and diastole. To date, global longitudinal strain (GLS) has been extensively studied in cardiology. It is now well established that GLS is more sensitive than left ventricular ejection fraction with 2D echocardiography in detecting systolic function impairment. It is also superior to left ventricular ejection fraction in the prediction of major cardio-vascular events. In the intensive care unit (ICU) setting, data are scarce. In experimental model and human studies in septic shock, speckle-tracking analysis suggests that GSL is impaired along with preserved left ventricular ejection fraction. Recent data also suggest that GLS impairment could predict in-ICU mortality in septic shock. In severe subarachnoid haemorrhage patients, speckle-tracking analysis could be more sensitive in detecting stress cardiomyopathy. However, there are many gaps to fill in the critically ill patient. For instance, the influence of mechanical ventilation on GLS is not fully elucidated, and there are, to date, too few data to exactly assess potential GLS alterations on the patient’s outcome. Nonetheless, this new tool provides objective and sensitive data with acceptable intra and inter-observer variability and may be of primary interest in the evaluation of left-ventricular systolic function in the ICU.

Speckle tracking analysis allows sensitive detection of stress cardiomyopathy in severe aneurysmal subarachnoid hemorrhage patients

International audiencePURPOSE: Stress cardiomyopathy is a common life-threatening complication after aneurysmal subarachnoid hemorrhage (SAH). We hypothesized that left ventricular (LV) longitudinal strain alterations assessed with speckle tracking could identify early systolic function impairment. METHODS: This was an observational single-center prospective pilot controlled study conducted in a neuro-intensive care unit. Forty-six patients with severe SAH with a World Federation of Neurological Surgeons grade (WFNS) ≥III were included. Transthoracic echocardiography (TTE) was performed on day 1, day 3, and day 7 after the patient's admission. A cardiologist blinded to the patient's management analyzed the LV global longitudinal strain (GLS). The control group comprised normal subjects matched according to gender and age. RESULTS: On day 1 median (25th-75th percentile) GLS was clearly impaired in SAH patients compared to controls [-16.7 (-18.7/-13.7) % versus -20 (-22/-19) %, p \textless 0.0001], whereas LVEF was preserved [65 (59-70) %]. GLS was severely impaired in patients with a WFNS score of V versus III-IV [-15.6 (-16.9/-12.3) % versus -17.8 (-20.6/-15.8) %, p = 0.008]. Seventeen (37 %) patients had a severe GLS alteration (\textgreater-16 %). In these patients, GLS improved from day 1 [-12.4 (-14.8/-10.9) %] to last evaluation [-16.2 (-19/-14.6) %, p = 0.0007] in agreement with the natural evolution of stress cardiomyopathy. CONCLUSIONS: On the basis of LV GLS assessment, we demonstrated for the first time that myocardial alteration compatible with a stress cardiomyopathy is detectable in up to 37 % of patients with severe SAH while LVEF is preserved. GLS could be used for sensitive detection of stress cardiomyopathy. This is critical because cardiac impairment remains a major cause of morbidity and mortality after SA

National security to guarantee the business entrepreneurship as a form of participation in the productive development of the country under the post-conflict

La presente investigación está orientada a evidenciar que en la actualidad el emprendimiento representa un elemento fundamental para el desarrollo del país toda vez que coadyuvan a renovar el tejido productivo de la sociedad y ofrecer nuevas oportunidades de desarrollo socio-económico que potencien el desarrollo de empresas que propendan por alcanzar niveles de productividad acorde a las necesidades apremiantes del país. En este ensayo, se evidenciará el primera medida, una reflexión y análisis del concepto del Emprendimiento desde lo conceptual y epistemológico que permitirá ir avanzando a la definición del emprendimiento empresarial, teniendo en cuenta que el modelo económico y la situación colombiana, presenta la potestad de dinamizar la economía a las empresas y personas; que con los procesos de integración económicas obliga para lo local y también con una visión global. El modelo económico actual, es catalogado como neoliberal, impregnado de máximas como: competitividad, productividad, rentabilidad; significando para algunas empresas y personas: absorción de mercados, alianzas, fusiones; y, para muchos, fracaso, fragmentación, exclusión y pobreza, entre otros flagelos. Lo cierto es que las tendencias son la integración y globalización de las economías y los mercados. Ante esa realidad, se describe la situación del caso colombiano, como sigue: el mercado, marca la diferencia entre países desarrollados, y los llamados “subdesarrollados” o en palabras de (Drucker’s, 2006) “mal administrados”, por muchas razones, sobresaliendo sus condicionamientos históricos, acentuado por procesos de violencia, migración, asilo interno o desplazamiento ante la colonización que según las épocas, se ha disfrazado con diferentes palabras y actores.The present investigation is orientated to demonstrate that at present the entrepreneurship represents a fundamental element for the development of the country although they contribute to renewing the productive fabric of the company and offering new opportunities of socio-economic development that promote the development of companies that they tend for reaching levels of identical productivity to the urgent needs of the country. In this test, there will be demonstrated the first measure, a reflection and analysis of the concept of the entrepreneurship from the conceptual thing and epistemology that will allow to be advancing to the definition of the managerial entrepreneurship, bearing in mind that the economic model and the Colombian situation, presents the legal authority to stir the economy into action to the companies and persons; that with the processes of integration economic forces for the local thing and also with a global vision. The economic current model, is catalogued as neoliberal impregnated with maxims as: competitiveness, productivity, profitability; meaning for some companies and persons: absorption of markets, alliances, mergers; and, for many, I fail, fragmentation, exclusion and poverty, between other scourges. The certain thing is that the trends are the integration and globalization of the economies and the markets. Before this reality, there is described the situation of the Colombian case, as it continues: the market, it marks the difference between developed countries, and the so called "underdeveloped ones" or in words " badly administered" (Drucker’s, 2006), for many reasons, standing out his historical conditionings, accentuated by processes of violence, migration, internal asylum or displacement before the settling that according to the epochs, has disguised itself with different words and actors