Key result
Higher MAPSE and LV-LWFS are associated with ~16% lower myocardial injury risk in septic shock.
Why the study?
LVEF is inconsistently associated with poor outcomes in sepsis, and newer LV systolic function parameters may be more sensitive indicators of dysfunction but remain sparsely investigated.
Are traditional and novel echocardiographic parameters of LV systolic function associated with myocardial injury, organ failure, and mortality in patients with septic shock?
Observational (n=152)
Yes
Are traditional and novel echocardiographic parameters of LV systolic function associated with myocardial injury, organ failure, and mortality in patients with septic shock?
Effect estimate: aOR 0.84 (95% CI 0.70-0.99)
p-value: p=0.04
In patients with septic shock, novel echocardiographic parameters MAPSE and LV-LWFS are independently associated with myocardial injury and outperform traditional measures like LVEF, though they do not predict short-term mortality or organ support needs.
MAPSE and LV-LWFS may flag myocardial injury when LVEF does not in septic shock; hypothesis-generating and should not yet change practice.
BACKGROUND: Left ventricular ejection fraction (LVEF) is inconsistently associated with poor outcomes in patients with sepsis. Newer parameters such as LV longitudinal strain (LVLS), mitral annular plane systolic excursion (MAPSE) and LV longitudinal wall fractional shortening (LV-LWFS) may be more sensitive indicators of LV dysfunction, but are sparsely investigated. Our objective was to evaluate the association between five traditional and novel echocardiographic parameters of LV systolic function (LVEF, peak tissue Doppler velocity at the mitral valve (s´), LVLS, MAPSE and LV-LWFS) and outcomes in patients admitted to the Intensive Care Unit (ICU) with septic shock. METHODS: A total of 152 patients admitted to the ICU with septic shock from two data repositories were included. Transthoracic echocardiograms were performed within 24 h of ICU admission. The primary outcome was myocardial injury, defined as high-sensitivity troponin T ≥ 45 ng/L on ICU admission. Secondary outcomes were organ support-free days (OSFD) and 30-day mortality. We also tested for the prognostic value of the systolic function parameters using multivariable analysis. RESULTS: LVLS, MAPSE and LV-LWFS, but not LVEF and s´, differed between patients with and without myocardial injury. After adjustment for age, pre-existing cardiac disease, Simplified Acute Physiology (SAPS3) score, Sequential Organ Failure Assessment (SOFA) score, plasma creatinine and presence of right ventricular dysfunction, only MAPSE and LV-LWFS were independently associated with myocardial injury. None of the systolic function parameters were associated with OSFD or 30-day mortality. CONCLUSIONS: MAPSE and LV-LWFS are independently associated with myocardial injury and outperform LVEF, s´ and LVLS. Whether these parameters are associated with clinical outcomes such as the need for organ support and short-term mortality is still unclear. Trial registration NCT01747187 and NCT04695119.
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Blixt et al. (2024) conducted an observational in Septic shock (n=152). MAPSE and LV-LWFS assessment vs. LVEF, s´, and LVLS was evaluated on Myocardial injury (high-sensitivity troponin T ≥ 45 ng/L on ICU admission) (aOR 0.84, 95% CI 0.70-0.99, p=0.04). MAPSE and LV-LWFS were independently associated with myocardial injury in patients with septic shock (aOR 0.84 and 0.85, respectively), whereas LVEF, s´, and LVLS were not.
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