1437: Lv Strain Predicts Long-Term Outcomes in Sepsis: A Retrospective Multicenter Study

Introduction: Sepsis survivors face an increased risk of long-term cardiovascular disease, yet traditional assessments often fail to identify those at risk. We investigated the prognostic utility of Left Ventricular Global Longitudinal Strain (LV GLS) in patients with sepsis and preserved Left ventricle Ejection fraction (LVEF), aiming to evaluate subclinical cardiac risk undetectable by the standard measure Methods: This retrospective study included 439 patients with sepsis or septic shock hospitalized between 2018–2022 at five Mayo Clinic sites (USA) and Hospital Alemán (Argentina). Echocardiographic strain imaging within 7 days of admission classified LV global longitudinal strain (GLS) as normal (–23% to –14%), hypercontractile (≤ –23%), or impaired (> –14%): 328 (74.7%) had normal, 31 (7.1%) low, and 80 (18.2%) high GLS. Outcomes were Major Adverse Cardiovascular Events (MACE: CV death, stroke, MI) and non-cardiovascular death. Fine–Gray and Cox models assessed associations, adjusting for demographics, comorbidities, SOFA score, lactate, mechanical ventilation, inotropes, vasopressors, and acute kidney injury. Results: Of 439 patients, 178 (40.5%) were female, with a median age of 62.9 years (overall) and 57.8 years (females). Among patients with preserved LVEF, impaired strain (> –14%) was significantly associated with MACE (adjusted sHR 1.58, 95% CI 1.10–2.20; p < 0.01), while LVEF itself was not (sHR 1.00, p = 0.99). MACE occurred over a median follow-up of 2.1 years (IQR 0.66–3.2), with 77 patients experiencing MACE during 595 patient-years of follow-up. Non-CV deaths occurred with a median time to death of 0.1 years (IQR 0.02–0.45). Hypercontractile strain (≤ –23%) was not associated with MACE but was independently predictive of non-CV death (adjusted sHR 1.93, p < 0.01), suggesting that elevated systolic function during sepsis could suggest persistent impaired cardiac function rather than cardiac recovery. Conclusions: This study reflects an area that needs to be studied for post-sepsis cardiac care; many patients at risk for long-term cardiovascular events may appear “normal” by LVEF but might have clinically significant systolic dysfunction detectable only by strain imaging. LV GLS could detect a high-risk subgroup within the preserved LVEF population and become a more reliable prognostic tool.