Sepsis-induced cardiomyopathy is associated with higher mortality rates in patients with sepsis

Hanumanthu, Balaram Krishna J; Nair, Anika Sasidharan; Katamreddy, Adarsh; Gilbert, Jason S; You, Jee Young; Offor, Obiageli Lynda; Kushwaha, Ankit; Krishnan, Ankita; Napolitano, Marzio; Palaidimos, Leonidas; Morante, Joaquin; Tekwani, Seema S.; Mehta, Samira K.; Gupta, Aanchal; Goraya, Harmeen; Sun, Mengyang; Faillace, Robert T.; Gulani, Perminder

doi:10.4266/acc.2021.00234

Cited by 25 publications

(22 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nowadays, SICM diagnosis does not count with a golden standard, which results in the use of different diagnostic criteria among researchers and a wide variation in the SICM incidence reports. In our study, this incidence, for all three diagnostic criteria, was about 20-40%, and thus similar to most literature reports 11,19,28 . The incidence of SICM, based on the LVEF criteria, was signi cantly lower than that based on GLS or TMAD, which might be related to the superiority of STE in detecting subclinical cardiac insu ciency 29 .…”

Section: Discussionsupporting

confidence: 92%

“…Left ventricular ejection fraction (LVEF) is the conventional indicator when evaluating LV systolic function. An LVEF onset of less than 50% is often considered as the diagnostic criteria for SICM [11][12][13][14] . In this regard, speckle tracking echocardiography (STE) is an angle-independent and semi-automatic method for LV strain measurements 15,16 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic value of tissue motion annular displacement in sepsis-induced cardiomyopathy: a single-center retrospective observational study

Song

Yao

Sun

et al. 2022

Preprint

View full text Add to dashboard Cite

Background Currently, there is no formal diagnostic criterion for sepsis-induced cardiomyopathy (SICM). The classic approach has been to use left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) to define SICM. In this regard, tissue motion annular displacement (TMAD) is a novel speckle tracking indicator to quickly assess LV longitudinal systolic function. This study aimed to evaluate the feasibility and application value of TMAD in the diagnosis of SICM in septic patients. Methods We conducted a single-center retrospective observational study in sepsis or septic shock patients who underwent echocardiography examination within the first 24h after admission. Basic clinical information and conventional echocardiographic data were collected. Based on speckle tracking echocardiography (STE), GLS and TMAD were respectively performed offline. The correlations between TMAD and other LV systolic function parameters, as well as the diagnostic value of TMAD for SICM, were assessed. Data of 28d and in-hospital mortality were compared between SICM and non-SICM patients. Results A total of 143 patients were enrolled in this study. The incidence of SICM according to GLS or TMAD criteria was significantly higher than that according to LVEF criteria (32.9% vs. 18.2%, p = 0.006; 38.5% vs. 18.2%, p < 0.001). The 28d and in-hospital mortality of SICM patients were significantly higher than the non-SICM patients according to any of the diagnostic criteria (all p < 0.05). Significant correlations between TMAD and other LV systolic function echocardiographic parameters, including LVEF, GLS, mitral annular plane systolic excursion (MAPSE), and maximal lateral systolic mitral annular tissue velocity (MA Smax), were detected (all p < 0.001). According to the AUROC value, TMADMid had an excellent diagnostic value for SICM (AUROC > 0.9). Compared with LVEF and GLS, TMAD had the highest intra-observer and inter-observer reliability. The mean time for off-line analyses with TMAD was significantly shorter than that with LVEF or GLS (p < 0.05). Conclusion STE-based TMAD is a feasible, reliable, and time-saving option to assess the LV systolic function. Overall, this approach shows an excellent diagnostic value for SICM in septic patients.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Diagnostic value of tissue motion annular displacement in sepsis-induced cardiomyopathy: a single-center retrospective observational study

Song

Yao

Sun

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Despite uncertainties about its precise definition, we defined SICM as LVEF < 50% in this study which was reported in most previous literature [ 28 ]. According to the definition, the SICM incidence in our study was similar to most previous reported studies [ 2 , 16 , 29 ]. Consistent with some previous investigations [ 6 , 7 ], SICM mortality in our study was significantly higher (about 2.5 times) than that of non-SICM patients.…”

Section: Discussionsupporting

confidence: 91%

“…Sepsis-induced cardiomyopathy (SICM), initially described in the 1980s, is generally defined as an acute and reversible cardiac dysfunction that involves decreased left and/or right ventricular systolic and/or diastolic function, left ventricular dilatation, and absence of acute coronary syndrome [ 1 ]. Although there is no formalized or consensus definition, the left ventricular ejection fraction (LVEF) of less than 50% is often considered as indicative of SICM [ 2 – 5 ] in most literature. SICM is commonly found in patients with sepsis, especially those with septic shock [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Feasibility and discriminatory value of tissue motion annular displacement in sepsis-induced cardiomyopathy: a single-center retrospective observational study

et al. 2022

View full text Add to dashboard Cite

Background There is no formal diagnostic criterion for sepsis-induced cardiomyopathy (SICM), but left ventricular ejection fraction (LVEF) < 50% was the most commonly used standard. Tissue motion annular displacement (TMAD) is a novel speckle tracking indicator to quickly assess LV longitudinal systolic function. This study aimed to evaluate the feasibility and discriminatory value of TMAD for predicting SICM, as well as prognostic value of TMAD for mortality. Methods We conducted a single-center retrospective observational study in patients with sepsis or septic shock who underwent echocardiography examination within the first 24 h after admission. Basic clinical information and conventional echocardiographic data, including mitral annular plane systolic excursion (MAPSE), were collected. Based on speckle tracking echocardiography (STE), global longitudinal strain (GLS) and TMAD were, respectively, performed offline. The parameters acquisition rate, inter- and intra-observer reliability, time consumed for measurement were assessed for the feasibility analysis. Areas under the receiver operating characteristic curves (AUROC) values were calculated to assess the discriminatory value of TMAD/GLS/MAPSE for predicting SICM, defined as LVEF < 50%. Kaplan–Meier survival curve analysis was performed according to the cutoff values in predicting SICM. Cox proportional hazards model was performed to determine the risk factors for 28d and in-hospital mortality. Results A total of 143 patients were enrolled in this study. Compared with LVEF, GLS or MAPSE, TMAD exhibited the highest parameter acquisition rate, intra- and inter-observer reliability. The mean time for offline analyses with TMAD was significantly shorter than that with LVEF or GLS (p < 0.05). According to the AUROC analysis, TMADMid presented an excellent discriminatory value for predicting SICM (AUROC > 0.9). Patients with lower TMADMid (< 9.75 mm) had significantly higher 28d and in-hospital mortality (both p < 0.05). The multivariate Cox proportional hazards model revealed that BMI and SOFA were the independent risk factors for 28d and in-hospital mortality in sepsis cases, but TMAD was not. Conclusion STE-based TMAD is a novel and feasible technology with promising discriminatory value for predicting SICM with LVEF < 50%.

show abstract

“…Therefore, the complex hemodynamic profiles may not have been fully quantified and accounted for in most critically ill septic patients [ 40 ]. Besides, the results of the previous studies could be biased due to the lack of adjustment of sepsis severity scores, different types of vasopressors, and other variables [ 2 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Association of sepsis-induced cardiomyopathy and mortality: a systematic review and meta-analysis

Lin

Lee

Toh

et al. 2022

Ann. Intensive Care

View full text Add to dashboard Cite

Background The implication of sepsis-induced cardiomyopathy (SIC) to prognosis is controversial, and its association with mortality at different stages remains unclear. We conducted a systematic review and meta-analysis to understand the association between SIC and mortality in septic patients. Methods We searched and appraised observational studies regarding the mortality related to SIC among septic patients in PubMed and Embase from inception until 8 July 2021. Outcomes comprised in-hospital and 1-month mortality. We adopted the random-effects model to examine the mortality risk ratio in patients with and without SIC. Meta-regression, subgroup, and sensitivity analyses were applied to examine the outcome’s heterogeneity. Results Our results, including 20 studies and 4,410 septic patients, demonstrated that SIC was non-statistically associated with increased in-hospital mortality, compared to non-SIC (RR 1.28, [0.96–1.71]; p = 0.09), but the association was statistically significant in patients with the hospital stay lengths longer than 10 days (RR 1.40, [1.02–1.93]; p = 0.04). Besides, SIC was significantly associated with a higher risk of 1-month mortality (RR 1.47, [1.17–1.86]; p < 0.01). Among SIC patients, right ventricular dysfunction was significantly associated with increased 1-month mortality (RR 1.72, [1.27–2.34]; p < 0.01), while left ventricular dysfunction was not (RR 1.33, [0.87–2.02]; p = 0.18). Conclusions With higher in-hospital mortality in those hospitalized longer than 10 days and 1-month mortality, our findings imply that SIC might continue influencing the host’s system even after recovery from cardiomyopathy. Besides, right ventricular dysfunction might play a crucial role in SIC-related mortality, and timely biventricular assessment is vital in managing septic patients.

show abstract

Sepsis-induced cardiomyopathy is associated with higher mortality rates in patients with sepsis

Cited by 25 publications

References 20 publications

Diagnostic value of tissue motion annular displacement in sepsis-induced cardiomyopathy: a single-center retrospective observational study

Diagnostic value of tissue motion annular displacement in sepsis-induced cardiomyopathy: a single-center retrospective observational study

Feasibility and discriminatory value of tissue motion annular displacement in sepsis-induced cardiomyopathy: a single-center retrospective observational study

Association of sepsis-induced cardiomyopathy and mortality: a systematic review and meta-analysis

Contact Info

Product

Resources

About