Echocardiographic evaluation of sepsis induced myocardial dysfunction in patients with sepsis or septic shock: a prospective cohort study

Abstract

Background: Sepsis-induced myocardial dysfunction (SIMD) occurs in 50% of septic patients and is characterized by reduced ejection fraction (EF), cardiac index, impaired contractility, and diastolic dysfunction (DD). In sepsis-induced cardiomyopathy (SICM), EF shows initial significant deterioration on the 1st day, then final improvement at the end of the study. This study evaluated the value of different parameters measured with trans-thoracic echocardiography (TTE) in the diagnosis and prognosis of SIMD in the surgical intensive care unit (SICU).

Methodology: This prospective cohort study was conducted on 100 patients, aged from 18 to 50 years admitted to SICU being affected by sepsis or septic shock. TTE parameters [EF, tricuspid annular systolic excursion (TAPSE), inferior vena cava (IVC) diameter, E/A ratio and grading of DD and hemodynamic parameters [mean arterial blood pressure (MAP), heart rate (HR), central venous pressure (CVP)] on admission, three day post-admission and after one week.

Results: The mortality rate was 45%. DD was found in 90%. The mortality group had higher DD, higher HR, and lower MAP than the surviving group, with an insignificant difference in LVEF, TAPSE, IVC, and CVP on the 3rd and 7th days. Sepsis-induced cardiomyopathy (SICM) was found in 31% of surviving patients. DD (grade III had the highest mortality followed by grade I then grade II), HR >110 bpm, and MAP < 65mmHg are independent factors that negatively affect the duration of survival significantly.

Conclusion: TTE in patients with sepsis or septic shock is vital for diagnosis and prognosis. DD, tachycardia (HR >110 bpm), and hypotension (MAP < 65mmHg) are independent predictors of mortality in those patients. Patients with SICM (little reversible impairment of LV systolic function) had a good prognosis.

 Keywords: Sepsis Induced Myocardial Dysfunction, Diastolic dysfunction, Sepsis, Septic Shock

Preregistration: The study was registered in the Ethical Committee of Faculty of Medicine, Tanta University, Tanta, Egypt (approval number: 31728/08/17)

Abbreviations: SIMD–Sepsis-induced myocardial dysfunction; SICM–sepsis-induced cardiomyopathy; TTE– transthoracic echocardiogram. EF–Ejection fraction; DD–diastolic dysfunction; MD–Myocardial dysfunction; TAPSE–tricuspid annular systolic excursion; SICU–surgical intensive care unit

Citation: El-Oraby MA, Shaban AES, El-Dada AA, El-Badawy AEH. Echocardiographic evaluation of sepsis induced myocardial dysfunction in patients with sepsis or septic shock: a prospective cohort study. Anaesth pain intensive care 2021;25(2):150-162. DOI: 10.35975/apic.v25i2.1463

Received: 6 November 2020, Reviewed: 30 December 2020, Accepted: 3 February 2021