Increasing illness severity is associated with global myocardial dysfunction in the first 24 hours of sepsis admission

Abstract

Background Septic cardiomyopathy was recognized more than 30 years ago, but the early phase remains uncharacterized as no existing studies captured patients at the time of Emergency Department (ED) presentation, prior to resuscitation. Therapeutic interventions alter cardiac function, thereby distorting the relationship with disease severity and outcomes. The goal of this study was to assess the impact of illness severity on cardiac function during the first 24 h of sepsis admission. Methods This was a pre-planned secondary analysis of a prospective observational study of adults presenting to the ED with suspected sepsis (treatment for infection plus either lactate > 2 mmol/liter or systolic blood pressure < 90 mm/Hg) who received < 1L IV fluid before enrollment. Patients had 3 echocardiograms performed (presentation, 3, and 24 h). The primary outcome was the effect of increasing sepsis illness severity, defined by ED Sequential Organ Failure Assessment (SOFA) score, on parameters of cardiac function, assessed using linear mixed-effects models. The secondary goal was to determine whether cardiac function differed between survivors and non-survivors, also using mixed-effects models. Results We enrolled 73 patients with a mean age of 60 (SD 16.1) years and in-hospital mortality of 23%. For the primary analysis, we found that increasing ED SOFA score was associated with worse cardiac function over the first 24 h across all assessed parameters of left-ventricular systolic and diastolic function as well as right-ventricular systolic function. While baseline strain and E/e' were better in survivors, in the mixed models analysis, the trajectory of Global Longitudinal Strain and septal E/e′ over the first 24 h of illness differed between survivors and non-survivors, with improved function at 24 h in non-survivors. Conclusions In the first study to capture patients prior to the initiation of resuscitation, we found a direct relationship between sepsis severity and global myocardial dysfunction. Future studies are needed to confirm these results, to identify myocardial depressants, and to investigate the link with adverse outcomes so that therapeutic interventions can be developed.

Correlation between tissue Doppler-derived left ventricular systolic velocity (S’) and left ventricle ejection fraction in sepsis and septic shock: a retrospective cohort study

“…Sepsis remains one of the leading causes of intensive care unit (ICU) mortality in the United States (U.S.) [ 1 ]. Cardiac dysfunction or sepsis-induced cardiomyopathy commonly occurs in this patient population, albeit with little consensus on appropriate definition for sepsis cardiomyopathy [ 2 ] and can be seen in up to 40–60% and has been shown to be associated with worse outcomes [ 3 , 4 ].…”

Echocardiography in the Assessment of Shock

“…It represents a more sensitive tool to spot subtle or early myocardial dysfunction. 35 This may prealert clinicians and impact their plans. However, STE requires high image quality, which is sometimes difficult to obtain in acute settings.…”

Global Longitudinal Strain by Speckle Tracking Echocardiography and Mortality in Septic Patients: an updated systematic review and meta-analysis with trial sequential analysis

“…Data on LVEF were available for thirteen of the fourteen studies included in the primary analysis [21][22][23][24][25][26][28][29][30][31][32][33][34] and showed a signi cant association between mortality and lower LVEF (MD:2.44%; [0.44,4.45]; p=0.02; I 2 =42%; Figure 3). A post-hoc analysis considering only the six studies clearly stating they used the Simpson's method for LVEF quanti cation resulted in no association between LVEF and survival (MD:2.51% [-0.60,5.62]; p=0.11; I 2 =45%).…”

“…After excluding 16 studies (in nine cases for overlap with subsequent publications), 13 new studies were included, but ve of them were included in the sensitivity analysis only. Hence, we included in the primary analysis eight studies identi ed by the update search, and the six studies already included in the previous metanalysis, resulting in a pool of 14 studies [21][22][23][24][25][26][27][28][29][30][31][32][33][34]. One of the included studies reported GLS at three time-points, and we chose the GLS at 24 hours, leaving the data collected at 0 and 3 hours for a sensitivity analysis [30].…”