Patterns of left and right ventricular dysfunction and their clinical outcomes in septic patients

To investigate the various types of left ventricular (LV) and right ventricular (RV) dysfunction and their association with clinical outcomes in septic patients. We retrospectively reviewed a cohort of sepsis and septic shock patients admitted to a tertiary hospital intensive care unit (ICU). Left ventricular dysfunction was determined by left ventricular ejection fraction (LVEF). Right ventricular systolic dysfunction (RVSD) was determined by tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), or RV S’ velocity. Cardiac function was categorized into five types: (1) normal cardiac function (LVEF > 50% but ≤ 70%, TAPSE ≥ 17 mm, RV FAC ≥ 35%, and RV S’ ≥9.5 cm/sec); (2) biventricular dysfunction (LVEF ≤ 50%, TAPSE < 17 mm or RV FAC < 35% or RV S’ < 9.5 cm/sec); (3) isolated LV dysfunction (LVEF ≤ 50%, TAPSE ≥ 17 mm, RV FAC ≥ 35%, and RV S’ ≥9.5 cm/sec); (4) isolated RV dysfunction (LVEF > 50%, TAPSE < 17 mm or RV FAC < 35% or RV S’ < 9.5 cm/sec); and (5) hyperdynamic LV function (LVEF > 70%, TAPSE ≥ 17 mm, RV FAC ≥ 35%, and RV S’ ≥9.5 cm/sec). The primary outcome was 30-day mortality. A cohort of 702 septic patients was analyzed. Patients with biventricular dysfunction (n = 113) and isolated RV dysfunction (n = 117) exhibited mortality rates of 34.5% and 36.7%, respectively. In comparison, lower mortality rates were observed in patients with isolated LV dysfunction (n = 72), hyperdynamic LV function (n = 86), and normal cardiac function (n = 314), with rates of 15.3%, 15.1% and 9.2%, respectively. Cox regression analysis confirmed that biventricular dysfunction (hazard ratio [HR] 2.312, 95% confidence interval [CI] 1.291–4.139, p = 0.005) and isolated RV dysfunction (HR 2.655, 95% CI 1.455–4.843, p = 0.001) were independently associated with 30-day mortality. Neither isolated LV dysfunction (HR 1.171, 95% CI 0.463–2.960, p = 0.739) nor hyperdynamic LV function (HR 2.153, 95% CI 0.971–4.773, p = 0.059) were independently associated with 30-day mortality. Septic patients with biventricular dysfunction or isolated RV dysfunction had significantly higher 30-day mortality rates compared to those with normal cardiac function. Notably, hyperdynamic LV function also showed a trend toward higher 30-day mortality than normal cardiac function, although this association did not reach statistical significance. In contrast, isolated LV dysfunction was not associated with 30-day mortality.