Hyperdynamic left ventricular ejection fraction in the intensive care unit

Abstract

IntroductionLimited information exists on the etiology, prevalence, and significance of hyperdynamic left ventricular ejection fraction (HDLVEF) in the intensive care unit (ICU). Our aim in the present study was to compare characteristics and outcomes of patients with HDLVEF with those of patients with normal left ventricular ejection fraction in the ICU using a large, public, deidentified critical care database.MethodsWe conducted a longitudinal, single-center, retrospective cohort study of adult patients who underwent echocardiography during a medical or surgical ICU admission at the Beth Israel Deaconess Medical Center using the Multiparameter Intelligent Monitoring in Intensive Care II database. The final cohort had 2867 patients, of whom 324 had HDLVEF, defined as an ejection fraction >70 %. Patients with an ejection fraction <55 % were excluded.ResultsCompared with critically ill patients with normal left ventricular ejection fraction, the finding of HDLVEF in critically ill patients was associated with female sex, increased age, and the diagnoses of hypertension and cancer. Patients with HDLVEF had increased 28-day mortality compared with those with normal ejection fraction in multivariate logistic regression analysis adjusted for age, sex, Sequential Organ Failure Assessment score, Elixhauser score for comorbidities, vasopressor use, and mechanical ventilation use (odds ratio 1.38, 95 % confidence interval 1.039–1.842, p =0.02).ConclusionsThe presence of HDLVEF portended increased 28-day mortality, and may be helpful as a gravity marker for prognosis in patients admitted to the ICU. Further research is warranted to gain a better understanding of how these patients respond to common interventions in the ICU and to determine if pharmacologic modulation of HDLVEF improves outcomes.

Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock: a systematic review and meta-analysis

“…Of course, LVEF variations are also related to changes in afterload more than in intrinsic myocardial contractility [ 14 ], and in this regard Vieillard-Baron et al repeatedly confirmed the variability in the incidence of systolic dysfunction as evaluated by LVEF at different time points after the onset of septic shock [ 11 , 51 ]. An independent association between hyperdynamic conditions (LVEF > 70%) and mortality was identified in a large retrospective cohort study of critically ill patients [ 63 ]. A further limitation in the estimation of systolic function by means of LVEF is the geometric assumptions.…”

The impact of a hyperdynamic left ventricle on right ventricular function measurements in preterm infants with a patent ductus arteriosus

“…In the adult population, a hyperdynamic LV is defined as an EF >70% 27. Very few of our infants developed an EF of 70% or greater.…”

Factors associated with abnormal left ventricular ejection fraction (decreased or increased) in patients with sepsis in the intensive care unit

“…Contrary to SIC, hyperdynamic LV ejection fraction (EF), which is defined as a LVEF > 70%, is frequently observed on transthoracic echocardiography (TTE) in the ICU [11]. Patients with sepsis commonly have low systemic vascular resistance and increased circulating catecholamines, and this causes increased contractility [12]. In terms of prognosis, a recent meta-analysis on sepsis-induced LV dysfunction showed there is no significant correlation between reduced EF and mortality [13].…”