J Korean Med Sci.  2020 Feb;35(4):e24. 10.3346/jkms.2020.35.e24.

Association between Left Ventricular Systolic Dysfunction and Mortality in Patients with Septic Shock

• Kim S
• Lee JD
• Kim BK
• Kim YH
• Kim JH

• KMID: 2468520
• DOI: http://doi.org/10.3346/jkms.2020.35.e24

Abstract

BACKGROUND
The impact of myocardial damage on the prognosis of patients with septic shock is not clearly elucidated because complex hemodynamic changes in sepsis obscure the direct relationship. We evaluated left ventricular (LV) conditions that reflect myocardial damage independently from hemodynamic changes in septic shock and their influence on the prognosis of patients.
METHODS
We retrospectively enrolled 208 adult patients who were admitted to the intensive care unit and underwent echocardiography within 7 days from the diagnosis of septic shock. Patients who were previously diagnosed with structural heart disease or coronary artery disease were excluded. Left ventricular ejection fraction (LVEF) was divided into four categories: normal, ≥ 50%; mild, ≥ 40%; moderate, ≥ 30%; and severe dysfunction, < 30%. Wall motion impairment was categorized into the following patterns: normal, diffuse, ballooning, and focal.
RESULTS
There were 141 patients with normal LVEF. Among patients with impaired LV wall motion, the diffuse pattern was the most common (34 patients), followed by the ballooning pattern (26 patients). Finally, 102 patients died, and in-hospital mortality was significantly higher in patients with severe LV systolic dysfunction (hazard ratio [HR], 1.97; 95% confidence interval [CI], 1.04-3.75; P = 0.039) and in patients with diffuse pattern of LV wall motion impairment (HR, 2.28; 95% CI, 1.19-4.36; P = 0.013) than in those with a normal LV systolic function.
CONCLUSION
Severe LV systolic dysfunction and diffuse pattern of LV wall motion impairment significantly affected in-hospital mortality in patients with septic shock. Conventional echocardiographic evaluation provides adequate information on the development of myocardial damage and accurately predicts the prognosis of patients with septic shock.

Keyword

Septic Shock; Septic Cardiomyopathy; Left Ventricular Systolic Function

MeSH Terms

Adult
Coronary Artery Disease
Diagnosis
Echocardiography
Heart Diseases
Hemodynamics
Hospital Mortality
Humans
Intensive Care Units
Mortality*
Prognosis
Retrospective Studies
Sepsis
Shock, Septic*
Stroke Volume