Prevalence and prognosis of hyperdynamic left ventricular systolic function in septic patients: a systematic review and meta-analysis

Abstract

Purpose The prevalence of hyperdynamic left ventricular (LV) systolic function in septic patients and its impact on mortality remain controversial. In this systematic review and meta-analysis, we investigated the prevalence and association of hyperdynamic LV systolic function with mortality in patients with sepsis. Methods We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. Primary outcomes were the prevalence of hyperdynamic LV systolic function in adult septic patients and the associated short-term mortality as compared to normal LV systolic function. Hyperdynamic LV systolic function was defined using LV ejection fraction (LVEF) of 70% as cutoff. Secondary outcomes were heart rate, LV end-diastolic diameter (LVEDD), and E/e’ ratio. Results Four studies were included, and the pooled prevalence of hyperdynamic LV systolic function was 18.2% ([95% confidence interval (CI) 12.5, 25.8]; I2 = 7.0%, P < 0.0001). Hyperdynamic LV systolic function was associated with higher mortality: odds ratio of 2.37 [95%CI 1.47, 3.80]; I2 = 79%, P < 0.01. No difference was found in E/e’ (P = 0.43) between normal and hyperdynamic LV systolic function, while higher values of heart rate (mean difference: 6.14 beats/min [95%CI 3.59, 8.69]; I2 = 51%, P < 0.0001) and LVEDD (mean difference: − 0.21 cm [95%CI − 0.33, − 0.09]; I2 = 73%, P < 0.001) were detected in patients with hyperdynamic LV systolic function. Conclusion The prevalence of hyperdynamic LV systolic function is not negligible in septic patients. Such a finding is associated with significantly higher short-term mortality as compared to normal LV systolic function.

Positive end-expiratory pressure and left ventricular function are key factors affecting right ventricular to pulmonary arterial coupling

“…As second key-point, Bowcock and Colleagues [ 1 ] assessed the impact of LV systolic function on TAPSE/TRV ratio according to the values of ejection fraction (LVEF), using a cut-off of 50% to identify systolic dysfunction with a dichotomic approach. However, for its effects on the outcomes of ICU patients, it is increasingly apparent that LVEF would be better treated as a continuous variable; indeed, both severely impaired LV systolic function (LVEF < 25%) as well as high values of LVEF (> 70%, hyperdynamic LV function) are associated with poorer prognosis [ 3 , 4 ]. We believe that further analysis may also consider describing LV systolic function with a continuous rather than dichotomic approach.…”