Korean Circ J.  2023 Dec;53(12):813-825. 10.4070/kcj.2023.0050.

Seven-day and In-hospital Mortality According to Left and Right Ventricular Dysfunction in Patients With Septic Shock

• Kim S
• Seok H
• Kim BK
• Kim YJ
• Lee SH
• Kim JH
• Kim YH

• KMID: 2548788
• DOI: http://doi.org/10.4070/kcj.2023.0050

Abstract

Background and Objectives
The prognostic implications of septic cardiomyopathy have not been clearly demonstrated. We evaluated serial changes in left ventricular (LV) and right ventricular (RV) function in patients with septic shock and their prognostic value on 7-day and in-hospital mortality.
Methods
Transthoracic echocardiography was performed within 48 hours of the diagnosis of septic shock and 7 days after the initial evaluation. In addition to traditional echocardiographic parameters, LV and RV function was evaluated using global longitudinal strain (GLS), and tricuspid annular plane systolic excursion (TAPSE).
Results
A total of 162 patients (men, 83, 51.5%; 70.7±13.4 years; Acute Physiology and Chronic Health Evaluation [APACHE] II, 30.6±9.2) were enrolled. Initial GLS and TAPSE were −14.9±5.2% and 16.9±5.5 mm, and improved in the follow-up evaluation (GLS, −17.6±4.9%; TAPSE, 19.2±5.4 mm). Seven-day and in-hospital mortality were 24 (14.9%) and 64 (39.8%). Seven-day mortality was significantly associated with initial GLS >−16% (odds ratio [OR], 14.066, 95% confidence interval [CI], 1.178–167.969, p=0.037) and APACHE II score (OR, 1.196, 95% CI, 1.047–1.365, p=0.008). The in-hospital mortality of 7-day survivors was associated with follow-up TAPSE <16 mm (OR, 10.109, 95% CI, 1.640–62.322, p=0.013) and Sequential Organ Failure Assessment score (OR, 1.340, 95% CI, 1.078–1.667, p=0.008). GLS was not associated with in-hospital mortality of 7-day survivors.
Conclusions
Fluctuation of both ventricular function was common in septic shock. Sevenday mortality of patients with septic shock was related to GLS, whereas in-hospital mortality of 7-day survivors was related to TAPSE, not to GLS.

Keyword

Sepsis; Shock; Cardiomyopathies; Mortality; Global longitudinal strain

Figure

• 

  Figure 1 The relationship of hemodynamic parameters and disease severity scoring systems to (A) GLS and (B) TAPSE in scattered diagram.GLS = global longitudinal strain; SOFA = Sequential Organ Failure Assessment; VIS = vasoactive-inotropic score; SVRI = systemic vascular resistance index; TAPSE = tricuspid annular plane systolic excursion.

• 

  Figure 2 Kaplan-Meier curves for the in-hospital mortality by GLS ≤−16% and >−16% and by TAPSE ≥16 mm and <16 mm in initial and follow-up TTE; (A, B) the curves of all patients evaluated by initial TTE evaluation; (C, D) curves of 7-day survivors by initial TTE evaluation; (E, F) curves of 7-day survivors by follow-up TTE evaluation.GLS = global longitudinal strain; LV = left ventricular; RV = right ventricular; TAPSE = tricuspid annular plane systolic excursion; TTE = transthoracic echocardiography.

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