Impact of Bi-ventricular systolic function on mortality in patients with sepsis and septic shock

Objectives: We aimed to evaluate left ventricular (LV) and right ventricular (RV) systolic performance in patients with sepsis or septic shock and possible functional alteration on in-hospital mortality. Patients and Methods: Thirty-seven consecutive patients with the diagnosis of sepsis or septic shock were included in the study. All patients underwent comprehensive transthoracic echocardiographic examination. Data of patients discharged from the intensive care unit was compared with data of patients who died in the hospital. Results: Fifteen patients (40.5%) survived, while 22 patients were died in the hospital (59.5%). A significant difference was detected between survivor and non-survivor groups regarding before discharge or death level of inflammatory markers such as CRP (p=0.05) and procalcitonin (p=0.03) besides BNP (p=0.01) and SOFA (p=0.009) score. There were two patients (5.4%) with EF value less than %50 in the study population. Eight patients (21.6%) displayed hypokinesia on the apical segment, and four patients (10.8%) had TAPSE values below 17 mm. One patient (6.6%) in the survivor group, but seven patients (31.8%) in the non-survivor group had apical hypokinesia with a trend towards significance (p=0.068). One patient in the survivor group (6.6%) and three patients (13.6%) in the non-survivor group had RV systolic dysfunction (p: 0.51). Conclusion: We found a much lower rate of LV and RV systolic dysfunction in patients with sepsis or septic shock compared with previous studies. None of the myocardial dysfunction types was associated with in-hospital mortality. Apical hypokinesia was also more prevalent in non-survivors despite borderline significance.

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Impact of New-Onset Left Ventricular Dysfunction on Outcomes in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock

Journal of Intensive Care Medicine ◽

10.1177/0885066616684774 ◽

2016 ◽

Vol 33 (12) ◽

pp. 680-686 ◽

Cited By ~ 2

Author(s):

Saraschandra Vallabhajosyula ◽

Shane M. Gillespie ◽

David W. Barbara ◽

Nandan S. Anavekar ◽

Juan N. Pulido

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Hospital Mortality ◽

Diastolic Dysfunction ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Ventricular Systolic Dysfunction ◽

Secondary Outcomes ◽

Sepsis And Septic Shock

Background: Left ventricular systolic dysfunction (LVSD) and LV diastolic dysfunction (LVDD) are commonly seen in severe sepsis and septic shock; however, their role in patients with concurrent invasive mechanical ventilation (IMV) is less well defined. Methods: This was a prospective observational study on all patients admitted to all the intensive care units (ICUs) at Mayo Clinic, Rochester from August 2007 to January 2009. All adult patients with severe sepsis and septic shock and concurrent IMV without prior heart failure underwent transthoracic echocardiography within 24 hours. Patients with active pregnancy, prior congenital or valvular heart disease, and prosthetic cardiac valves were excluded. Left ventricular systolic dysfunction was defined as LV ejection fraction (LVEF) <50% and LVDD as E/e′ >15. Primary outcome was hospital mortality, and secondary outcomes included IMV duration, ICU length of stay (LOS), and total LOS. Two-tailed P value of <.05 was considered statistically significant. Results: In a total of 106 patients, 58 (54.7%) met our inclusion criteria, with 17 (29.3%), 11 (19.0%), and 5 (8.6%) having LVSD, LVDD, and both, respectively. The cohorts with and without LVSD and LVDD did not differ significantly in their baseline characteristics and laboratory and ventilatory parameters. Compared to those without LVSD, patients with LVSD had higher LV end-systolic diameters but were not different in their left atrial diameters or E/e′ ratio. Patients with LVDD had a higher E velocity and E/e′ ratio compared to those without LVDD. Hospital mortality was not different in patients with and without LVSD (8 [47%] vs 21 [51%], P = 1.00) and LVDD (8 [73%] vs 21 [45%], P = .18). Secondary outcomes were not different between the 2 groups. Conclusion: Left ventricular systolic or diastolic dysfunction did not influence in-hospital outcomes in patients with severe sepsis and septic shock and concurrent IMV.

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Characterization of Myocardial Dysfunction in Fluid- and Catecholamine-Refractory Pediatric Septic Shock and Its Clinical Significance

Journal of Intensive Care Medicine ◽

10.1177/0885066616685247 ◽

2016 ◽

Vol 34 (1) ◽

pp. 17-25 ◽

Cited By ~ 6

Author(s):

Feifei Z. Williams ◽

Ritu Sachdeva ◽

Curtis D. Travers ◽

Karen H. Walson ◽

Kiran B. Hebbar

Keyword(s):

Septic Shock ◽

Intensive Care ◽

Clinical Significance ◽

Cold Shock ◽

Myocardial Dysfunction ◽

Systolic Dysfunction ◽

Severity Of Illness ◽

Left Ventricular ◽

Hospital Length Of Stay ◽

Z Score

Purpose: Myocardial dysfunction is a known complication in patients with pediatric septic shock (PSS); however, its clinical significance remains unclear. The purpose of this study was to characterize left ventricular (LV) and right ventricular (RV) dysfunction and their prevalence in patients with PSS using echocardiography (echo) and to investigate their associations with the severity of illness and clinical outcomes. Methods: Retrospective chart review between 2010 and 2015 from 2 tertiary care pediatric intensive care units. Study included 78 patients (mean age 9.3 ± 7 years) from birth up to 21 years who fulfilled criteria for fluid- and catecholamine-refractory septic shock. Echocardiographic parameters of systolic, diastolic, and global function were measured offline. They were correlated with admission Pediatric Risk of Mortality III (PRISM III) and Pediatric Logistic Organ Dysfunction scores, vasoactive–inotrope score (VIS), β-type natriuretic peptide (BNP), lactate, type of shock, duration of mechanical ventilation (MV), intensive care unit and hospital length of stay, and mortality. Results: Overall, 28-day mortality was 26%, and 88% patients required MV. Prevalence of LV dysfunction was 72% and RV dysfunction was 63%. LV systolic dysfunction (fractional shortening z score <−2) was significantly associated with PRISM III, VIS, and BNP. RV systolic dysfunction (tricuspid annular plane systolic excursion z score <−2) was significantly associated with cold shock. LV and RV diastolic dysfunction did not have any significant clinical associations. No echocardiographic measures were associated with mortality. Conclusion: Myocardial dysfunction is highly prevalent in PSS but is not associated with mortality. LV systolic dysfunction is associated with a higher severity of illness, use of vasoactives, and BNP, whereas RV systolic dysfunction is associated with cold shock. Further studies are needed to determine the utility of echo in the bedside management of patients with PSS.

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The Role of BCL2 Protein and Tumour Protein p53 in Septic Cardiomyopathy

Revista de Chimie ◽

10.37358/rc.70.19.11.7656 ◽

2019 ◽

Vol 70 (11) ◽

pp. 3842-3846

Author(s):

Peter Michael Reil ◽

Teodor Traian Maghiar ◽

Karlheinz Seidl ◽

Ciprian Borza ◽

Vharoon Nunkoo ◽

...

Keyword(s):

Septic Shock ◽

Systolic Function ◽

Myocardial Dysfunction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Septic Cardiomyopathy ◽

Ventricular Ejection Fraction ◽

P53 Expression ◽

Protein P53 ◽

Bcl2 Protein

A decreased left ventricular ejection fraction (LVEF) was observed in patients suffering from septic shock with normalization of systolic function after 10 days.�Similar courses of reversible myocardial dysfunction due to the systemic inflammatory response syndrome were also encountered in other critical illnesses. Since the pathological and histological mechanisms are not fully understood, the present study tries to understand the septic cardiomyopathy related to the apoptotic pathway. Thestudy included a number of 29�cases of adults that died of septic shock being analysed for BCL2 and p53 expression rates of myocardial tissue. This is the first time the expression of BCL2 protein, p53 tumour protein were evaluated in septic shock and septic cardiomyopathy of humans.�There was a strong link between the increased expression of BCL2 and of p53 protein in cardiac muscle cells in the studied group (p=0.0300).�The study showed a significant correlation between markedly increased values and poor outcome.

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Prognostic Role of Left Ventricular Systolic Function Measured by Speckle Tracking Echocardiography in Septic Shock

BioMed Research International ◽

10.1155/2020/7927353 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Pham Dang Hai ◽

Nguyen Thanh Binh ◽

Nguyen Viet Quang Hien ◽

Nguyen Huy Hoang ◽

Vu Ngoc Hoan ◽

...

Keyword(s):

Septic Shock ◽

Mortality Rate ◽

Hospital Mortality ◽

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Systolic Function ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Ventricular Systolic Function ◽

Lv Systolic Function

Background. Left ventricular (LV) systolic dysfunction is common in septic shock. Global longitudinal strain (GLS) measured by speckle tracking echocardiography (STE) is a useful marker of intrinsic left ventricular systolic function. However, the association between left ventricular GLS and outcome in septic patients is not well understood. We performed this prospective study to investigate the prognostic value of LV systolic function utilizing speckle tracking echocardiography in patients with septic shock. Methods. All the patients with septic shock based on sepsis-3 definition admitted to the intensive care unit were prospectively studied with STE within 24 hours after the onset of septic shock. Baseline clinical and echocardiographic variables were collected. The primary outcome was in-hospital mortality. Results. During a 19-month period, 90 consecutive patients were enrolled in the study. The in-hospital mortality rate was 43.3%. Compared with survivors, nonsurvivors exhibited significantly less negative GLS ( − 13.1 ± 3.3 % versus − 15.8 ± 2.9 % ; p < 0.001 ), which reflected worse LV systolic function. The area under the ROC curves of GLS for the prediction of mortality was 0.76 (95% CI 0.67 to 0.87). Patients with GLS > − 14.1 % showed a significantly higher mortality rate (67.7% versus 15.6%; p < 0.0001 ; log ‐ rank = 23.3 ; p < 0.0001 ). In the multivariate analysis, GLS (HR, 1.27; 95% CI 1.07 to 1.50, p = 0.005 ) and SOFA scores (HR, 1.27; 95% CI 1.08 to 1.50, p = 0.004 ) were independent predictors of in-hospital mortality. Conclusions. Our study indicated that LV systolic function measured by STE might be associated with mortality in patients with septic shock.

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Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with Septic Shock

Journal of Clinical Medicine ◽

10.3390/jcm8020239 ◽

2019 ◽

Vol 8 (2) ◽

pp. 239 ◽

Cited By ~ 7

Author(s):

June-sung Kim ◽

Muyeol Kim ◽

Youn-Jung Kim ◽

Seung Mok Ryoo ◽

Chang Hwan Sohn ◽

...

Keyword(s):

Septic Shock ◽

Confidence Interval ◽

Diastolic Dysfunction ◽

Odds Ratio ◽

Troponin I ◽

Myocardial Dysfunction ◽

Systolic Dysfunction ◽

Area Under The Curve ◽

Regional Wall Motion ◽

Left Ventricular

(1) Background: Myocardial dysfunction in patients with sepsis is not an uncommon phenomenon, yet reported results are conflicting and there is no objective definition. Measurement of troponin may reflect the state of the heart and may correlate with echocardiographically derived data. This study aimed to evaluate the role of admission and peak troponin-I testing for the identification of sepsis-induced myocardial dysfunction (SIMD) by transthoracic echocardiography (TTE). (2) Methods: This was a retrospective cohort study using a prospective registry of septic shock at an Emergency Department from January 2011 and April 2017. All 1,776 consecutive adult septic shock patients treated with protocol-driven resuscitation bundle therapy and tested troponin-I were enrolled. SIMD was defined as left ventricular (LV) systolic/diastolic dysfunction, right ventricular (RV) diastolic dysfunction, or global/regional wall motion abnormalities (WMA). (3) Results: Of 660 (38.4%) septic shock patients with an elevated hs-TnI (≥0.04 ng/mL) at admission, 397 patients underwent TTE and 258 cases (65%) showed SIMD (LV systolic dysfunction (n = 163, 63.2%), LV diastolic dysfunction (n = 104, 40.3%), RV dysfunction (n = 97, 37.6%), and WMA (n = 186, 72.1%)). In multivariate analysis, peak hs-TnI (odds ratio 1.03, 95% confidence interval 1.01–1.06, p = 0.008) and ST-T wave changes in the electrocardiogram (odds ratio 1.82, 95% confidence interval 1.04–2.39, p = 0.013) were associated with SIMD, in contrast to hs-TnI level at admission. The area under the curve of peak hs-TnI was 0.668. When the peak hs-TnI cutoff value was 0.634 ng/mL, the sensitivity and specificity for SIMD were 58.6% and 59.1%, respectively. 4) Conclusions: About two-thirds of patients with an elevated hs-TnI level have various cardiac dysfunctions in terms of TTE. Rather than the initial level, the peak hs-TnI and ST-T change may be considered as a risk factor of SIMD.

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The application experience of focused ultrasound heart examination in patients with COVID-19 in Prone-position

Medical Visualization ◽

10.24835/1607-0763-990 ◽

2021 ◽

Vol 25 (3) ◽

pp. 13-21

Author(s):

N. I. Belavina ◽

R. T. Iskhakov ◽

I. V. Barkova ◽

E. S. Ilina ◽

I. A. Kesareva ◽

...

Keyword(s):

Mechanical Ventilation ◽

Prone Position ◽

Focused Ultrasound ◽

Systolic Function ◽

Systolic Dysfunction ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

The State ◽

Significant Difference ◽

The Right

Aim of the study. To study the experience of using focused transthoracic echocardiography in patients with COVID-19 in prone position (fEchoPr) in intensive care units (ICU).Materials and methods. The retrospective observational study included 53 patients (period from 15 April to 31 December 2020). Inclusion criteria: confirmed diagnosis of COVID-19, availability of fEchoPr data, outcome certainty (discharge/death). We analyzed electronic medical records. The fEchoPr was performed in patients in the prone position with a bolster under the left side of the chest and left arm raised (‘swimmer’s position’). We assessed the systolic function of the right ventricle (RV) (tricuspid annular plane systolic excursion (TAPSE)), RV size, RV/LV ratio, systolic function of the left ventricle (LV) (left ventricular outflow tract velocity time integral. (LVOT VTI)), and pulmonary hypertension (PH) (tricuspid regurgitation peak gradient (PGTR). Depending on the results, the patients were divided into 2 groups: informative (+fEchoPr) and non-informative (–fEchoPr) examinations.Results. There was no statistically significant difference in the groups (+fEcho n = 35 vs –fEcho n = 18) by age (65.6 ± 15.3 vs 60.2 ± 15.8, p > 0.05), by gender (male: 23 (65.7%) vs 14 (77.8%), p > 0.05), by body mass index (31.3 ± 5.3 kg/m 2 vs 29.5 ± 5.4 kg/m2 , p > 0.05), by mechanical ventilation support (24 (68.6%) vs 17 (94.4%), p = 0.074), by NEWS scale indicators (6.9 ± 3.7 vs 8.5 ± 3.5 points), by mortality (82.8% vs 94.4%, p > 0.05). Correlation analysis revealed a moderate inverse relationship between being on mechanical ventilation and the informative value of the study (Spearman's r = −0.30 at p = 0.033). In the +fEchoPr group, the correct measurement of TAPSE and RV/LV was carried out in 100%: a decrease in RV systolic function was recorded in 5 patients (14%), expansion of the RV in 13 patients (37%). Signs of PH were detected in 11 patients (31%), PGTR could not be measured in 10 patients (28%). LV systolic dysfunction was detected in 7 patients (20%). No pathology was detected in 16 patients (46%). One patient was diagnosed with infective endocarditis of native mitral valve, which was later confirmed by autopsy.Conclusion. In 66% of cases, fEchoPr examinations were informative, especially in terms of assessing the state of the right heart. fEchoPr examination is an affordable, valid and reproducible method to assess and monitor the state of the heart in ICU patients.

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Non-Invasive Imaging for Evaluating Cardiovascular Involvement in Patients with Primary and Lupus Nephritis

The Open Rheumatology Journal ◽

10.2174/1874312901913010086 ◽

2019 ◽

Vol 13 (1) ◽

pp. 86-93

Author(s):

Marco Atteritano ◽

Luca Visconti ◽

Giuseppe Dattilo ◽

Carmelo Zuppardo ◽

Antonio Lacquaniti ◽

...

Keyword(s):

Carotid Artery ◽

Systolic Function ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Carotid Bifurcation ◽

Left Ventricular ◽

Control Group ◽

Carotid Imt ◽

2D Echocardiography ◽

Significant Difference

Background: Evidence suggests that proteinuric diseases, such as primary or secondary glomerulonephritis, increase cardiovascular risk, but few studies confirmed this association. Methods: This is a cross-sectional, observational study on 32 patients, 17 with Primary Glomerulonephritis (PG) and 15 with Lupus Glomerulonephritis (LG). The control group consisted of 32 healthy individuals. Intima-media thickness (IMT) of the left common carotid artery, carotid bifurcation and internal carotid artery was measured by ultrasound. Left ventricular myocardial deformation was assessed by the use of the Global Circumferential Strain (GCS) and the Global Longitudinal Strain (GLS) following 2-Dimensional (2D) echocardiography in all participants. Results: Patients with glomerulonephritis in both groups showed significantly lower GLS compared with controls (p=0.0005). There was also a significant difference in common carotid IMT values between the LG and GP group (0.45±0.09 vs. 0.58±0.17 mm, respectively; p=0.01), but there was no difference with the control group. In patient group (n=32), a significantly positive correlation was observed between C-reactive protein and proteinuria (r=0.98; p<0.0001), whereas negative correlations were found between common carotid IMT and creatinine clearance (r=-0.97; p<0.0001) and between carotid bifurcation IMT and phosphate levels (r=-0.97; p<0.0001) Conclusion: Subclinical systolic myocardial dysfunction is present early in the course of glomerular disease. The use of 2D GLS revealed that LG and PG patients with no cardiovascular symptoms or history and a preserved left ventricle ejection fraction on conventional echocardiography had subclinical reduction in LV global longitudinal systolic function compared with controls.

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Hidden Danger of COVID-19 Outbreak: Evaluation of Subclinical Myocardial Dysfunction in Patients with Mild Symptoms

10.21203/rs.3.rs-412750/v1 ◽

2021 ◽

Author(s):

Murat GUL ◽

Sinan INCI ◽

Halil AKTAS ◽

Oguz YILDIRIM ◽

Yakup ALSANCAK

Keyword(s):

Longitudinal Strain ◽

Myocardial Dysfunction ◽

Systolic Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Public Health Issue ◽

Cardiac Complications ◽

Global Public Health ◽

Presenting Symptoms ◽

Significant Difference

Abstract Background: The COVID 19 infection, which is caused by the novel coronavirus SARS-CoV-2, has rapidly emerged as a global public health issue. Cardiac complications secondary to this infection are common and associated with mortality. This study aimed to evaluate whether subclinical myocardial dysfunction using left ventricular global longitudinal strain (LVGLS) in non-hospitalized mildly symptomatic COVID-19 patients.Methods: In this cross-sectional, single-center study, data were collected from non-hospitalized mildly symptomatic COVID-19 patients between January 01 and February 01, 2021. Fifty (26 male, 24 female) COVID-19 patients and 50 age- and sex-matched healthy volunteers have included in the study. Apical four-, three-, and two-chamber images were analyzed longitudinally by conventional methods and speckle tracking echocardiography (STE) for left ventricle functions.Results: The mean age of the COVID-19 patients was 39.55±8.96, 52% of them were male. The most prevalent presenting symptoms were fever (in 34 (68%)), asthenia (in 30 (60%)), loss of appetite (in 21 (42%)), myalgia (in 20 (40%)), and cough (in 13 (26%)). Plasma levels of C-reactive protein (CRP) were significantly higher in the COVID-19 patients than in the controls (10.84±12.44 vs. 4.50±2.81, p < 0.001). There was no significant difference between the groups in terms of standard echocardiography and Doppler parameters (p>0.05). Left ventricular longitudinal strain and strain velocity parameters were significantly decreased in COVID-19 patients compared to healthy individuals. LV-GLS values (-21,72 ± 3,85% vs. -23,11 ± 4,16%; P =0,003) were significantly lower in COVID-19 patients when compared with the healthy controls.Conclusion: Mildly symptomatic COVID-19 patients also have subclinical myocardial dysfunction similar to hospitalized patients. STE has the potential for detecting subclinical LV systolic dysfunction and can provide useful information on the risk stratification in the mildly symptomatic COVID-19 population.

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P316 A feasible and accurate method for the assessment of early ventricular dysfunction in children with kawasaki disease: result from the MyoWoRK (myocardial work related to kawasaki disease) study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.169 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

N S Borrelli ◽

G Di Salvo ◽

J Sabatino ◽

M Avesani ◽

E Filippini ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Systolic Function ◽

Myocardial Dysfunction ◽

Left Ventricular ◽

Unknown Etiology ◽

Male Age ◽

Significant Difference ◽

Global Work ◽

Lv Systolic Function

Abstract Funding Acknowledgements EACVI Training Grant Introduction Kawasaki disease (KD) is an acute vasculitis of unknown etiology. It is associated with high morbidity and mortality due to the development of coronary artery aneurysms and myocardial dysfunction. Purpose The aim of this study was to evaluate sensitivity and specificity of left ventricular (LV) pressure–strain loop (PSL) area, which reflects regional myocardial work and metabolic demand, in predicting subtle myocardial abnormalities in KD patients with coronaries aneurisms. Methods A total of 88 patients (59 male, age 8.95 ± 4.95 years) were included in our study. Among the children admitted in our institution with a diagnosis of KD during the study time frame, 42 patients (KDg) (29 male) with coronary artery dilatation (Z-score >2.5) were selected. These cases were compared with 46 (30 male) age-matched controls (CTRg). Classical echocardiographic parameters of LV systolic function were normal in both groups, while global longitudinal strain (GLS) was decreased in 6 KD patients. Global work index (GWI) was calculated as the area of the LV PSL. From GWI, it was estimated also Global Constructive Work (GCW), Global Wasted Work (GWW) and Global Work Efficiency (GWE). We also made a subgroup analysis between KD patients with normal GLS (> -19 %) and control patients. Results Despite normal LV systolic function by routine echocardiography, compared to controls, KD patients had lower GWI (1448 ± 382 mmHg% in KDg vs 1751 ± 263] mmHg% in CTRg, p = 0.00003), GCW (1904 ± 390 mmHg% in KDg vs 2174 ± 292 mmHg% in CTRg, p= 0.0004) and GWE (94 ± 5 % in KDg vs 96 ± 2 % in CTRg, p= 0.01). There was not significant difference in GWW between the KDg and CTRg. When KD patients with normal GLS were analysed separately, they preserved a significant difference in GWI, GCW and GWE in comparison with controls (GWI: 1490 ± 347 mmHg% in KDg vs 1751 ± 263 mmHg% in CTRg, p = 0.0002; GCW: 1972 ± 321 mmHg% in KDg vs 2174 ± 292 mmHg% in CTRg, p = 0.004; GWE: 95 ± 3 in KDg vs 96 ± 2 % in CTRg, p= 0.04). No association was found between GWI, GCW, GWW, GWE and number or dimension of the involved aneurysmatic coronaries. Conclusions The estimation of myocardial work by PSL is a novel tool for the evaluation of patients with KD. GWI, GCW and GWE were significantly reduced in KD patients with dilated coronaries. In KD patients with normal GLS, estimation of GWI, GCW and GWE may be a sensitive indicator of myocardial dysfunction and an adjuvant criterion to avoid delayed diagnosis of KD. Abstract P316 Figure. Myocardial work in KD and CTR.

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