Prognostic role of deformation imaging in sepsis-induced cardiomyopathy

Abstract Background Sepsis is a life-threatening condition characterized by a dysregulated host response to infection, frequently resulting in organ dysfunction. One of its notable cardiac manifestations, septic cardiomyopathy, presents as a transient, non-ischemic myocardial dysfunction predominantly seen in critically ill patients. This condition is typically associated with reversible left ventricular systolic dysfunction, often resolving within one week. While left ventricular ejection fraction (LVEF) remains a commonly used measure of systolic function, it may not fully reflect the subtle myocardial impairments occurring during sepsis. Recent evidence has emphasized the diagnostic potential of advanced echocardiographic metrics such as ventricular strain and myocardial work, which provide more sensitive and comprehensive assessments of cardiac function in this population. Methods In this prospective study, patients aged 18 to 85 years who were admitted to the intensive care unit (ICU) with a confirmed diagnosis of sepsis were considered for inclusion. Patients who were intubated or receiving vasopressor therapy at the time of enrollment were excluded. A total of 90 patients without a prior history of heart failure were initially screened; 13 were subsequently excluded due to intubation, vasopressor initiation, or death prior to echocardiographic evaluation. Ultimately, 77 patients were included in the final analysis. All participants underwent bedside transthoracic echocardiography, including strain assessment. Clinical outcomes—such as the onset of shock, all-cause mortality, and major adverse cardiovascular events (MACE)—were prospectively recorded during follow-up. Results Shock developed in 34 patients, and 30 deaths occurred during the follow-up period. The median time to shock onset was 2 days (interquartile range: 1–3.8 days). Receiver operating characteristic (ROC) analysis revealed that left ventricular global longitudinal strain (LVGLS) had the highest predictive value for clinical endpoints, with an area under the curve (AUC) of 0.85 (95% CI: 0.75–0.92), significantly outperforming LVEF and LVOT pulse wave Doppler (p 0.05 for all; Figure 1). At a cut-off value of -18%, LVGLS demonstrated a sensitivity of 79.4% and specificity of 78.9%. Conclusions In patients with sepsis, LVGLS is a significant predictor of clinical outcome. It outperforms conventional echocardiographic parameters and may serve as a more reliable marker for early risk stratification in this critically ill population.