Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 18;14(1):12.
doi: 10.1186/s13613-023-01235-5.

Association between left ventricular systolic function parameters and myocardial injury, organ failure and mortality in patients with septic shock

Patrik Johansson Blixt  1 , Maxime Nguyen  2 , Bernard Cholley  3   4 , Fredrik Hammarskjöld  5 , Alois Toiron  3 , Belaid Bouhemad  2 , Shaun Lee  6 , Lina De Geer  1 , Henrik Andersson  1 , Meriam Åström Aneq  7 , Jan Engvall  7 , Michelle S Chew  8
Affiliations

Association between left ventricular systolic function parameters and myocardial injury, organ failure and mortality in patients with septic shock

Patrik Johansson Blixt et al. Ann Intensive Care. .

Abstract

Background: Left ventricular ejection fraction (LVEF) is inconsistently associated with poor outcomes in patients with sepsis. Newer parameters such as LV longitudinal strain (LVLS), mitral annular plane systolic excursion (MAPSE) and LV longitudinal wall fractional shortening (LV-LWFS) may be more sensitive indicators of LV dysfunction, but are sparsely investigated. Our objective was to evaluate the association between five traditional and novel echocardiographic parameters of LV systolic function (LVEF, peak tissue Doppler velocity at the mitral valve (s´), LVLS, MAPSE and LV-LWFS) and outcomes in patients admitted to the Intensive Care Unit (ICU) with septic shock.

Methods: A total of 152 patients admitted to the ICU with septic shock from two data repositories were included. Transthoracic echocardiograms were performed within 24 h of ICU admission. The primary outcome was myocardial injury, defined as high-sensitivity troponin T ≥ 45 ng/L on ICU admission. Secondary outcomes were organ support-free days (OSFD) and 30-day mortality. We also tested for the prognostic value of the systolic function parameters using multivariable analysis.

Results: LVLS, MAPSE and LV-LWFS, but not LVEF and s´, differed between patients with and without myocardial injury. After adjustment for age, pre-existing cardiac disease, Simplified Acute Physiology (SAPS3) score, Sequential Organ Failure Assessment (SOFA) score, plasma creatinine and presence of right ventricular dysfunction, only MAPSE and LV-LWFS were independently associated with myocardial injury. None of the systolic function parameters were associated with OSFD or 30-day mortality.

Conclusions: MAPSE and LV-LWFS are independently associated with myocardial injury and outperform LVEF, s´ and LVLS. Whether these parameters are associated with clinical outcomes such as the need for organ support and short-term mortality is still unclear. Trial registration NCT01747187 and NCT04695119.

Keywords: Left ventricle; MAPSE; Myocardial injury; Organ failure; Septic shock; Strain; Systolic function.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Measurement of MAPSE and VL
Fig. 2
Fig. 2
Inclusion and exclusion flowchart
See this image and copyright information in PMC

References

    1. Vallabhajosyula S, Pruthi S, Shah S, Wiley BM, Mankad SV, Jentzer JC. Basic and advanced echocardiographic evaluation of myocardial dysfunction in sepsis and septic shock. Anaesth Intensive Care. 2018;46(1):13–24. doi: 10.1177/0310057X1804600104. - DOI - PubMed
    1. Ehrman RR, Sullivan AN, Favot MJ, Sherwin RL, Reynolds CA, Abidov A, et al. Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: a review of the literature. Crit Care. 2018;22(1):112. doi: 10.1186/s13054-018-2043-8. - DOI - PMC - PubMed
    1. Sanfilippo F, Huang S, Messina A, Franchi F, Oliveri F, Vieillard-Baron A, et al. Systolic dysfunction as evaluated by tissue Doppler imaging echocardiography and mortality in septic patients: a systematic review and meta-analysis. J Crit Care. 2021;62:256–264. doi: 10.1016/j.jcrc.2020.12.026. - DOI - PubMed
    1. Beesley SJ, Sorensen J, Walkey AJ, Tonna JE, Lanspa MJ, Hirshberg E, Grissom CK, Horne BD, Burk R, Abraham TP, Paine R, Brown SM. Long-term implications of abnormal left ventricular strain during sepsis. Crit Care Med. 2021;49(4):e444–e453. doi: 10.1097/CCM.0000000000004886. - DOI - PMC - PubMed
    1. Dugar S, Sato R, Chawla S, Young J, Wang X, Grimm R, et al. Is left ventricular systolic dysfunction associated with increased mortality among patients with sepsis and septic shock? Chest. 2023;S0012–3692(23):00111–113. - PubMed

Associated data