Hyperdynamic Left Ventricular Ejection Fraction in ICU Patients With Sepsis

Minesh Chotalia; Muzzammil Ali; Ravi Hebballi; Harjot Singh; Dhruv Parekh; Mansoor N. Bangash

doi:10.1097/ccm.0000000000005315

October 4, 2021Critical Care Medicine

Hyperdynamic Left Ventricular Ejection Fraction in ICU Patients With Sepsis

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Why the study?

To evaluate the cause and prognosis of hyperdynamic left ventricular ejection fraction in critically ill patients with sepsis.

Key Points

To determine the underlying causes and prognostic value of hyperdynamic left ventricular ejection fraction in critically ill patients with sepsis.
Retrospective, single-center cohort study conducted in an ICU in Birmingham, United Kingdom, including 1,014 patients who received a transthoracic echocardiogram within 7 days of sepsis onset between 2016 and 2019.
Categorized left ventricular ejection fraction (LVEF) into normal (55–70%), depressed (<55%), and hyperdynamic (>70%) phenotypes.
Evaluated 90-day mortality and clinical predictors across phenotypes using multivariate logistic regression.
Ninety-day mortality was significantly higher in patients with hyperdynamic LVEF (58.9% [n=103]) compared to those with depressed (34.0% [n=55]) and normal LVEF (24.7% [n=167]; p < 0.0001).
Multivariate analysis showed hyperdynamic LVEF independently predicted 90-day mortality (odds ratio [OR], 3.90; 95% CI, 2.09–7.40), whereas depressed LVEF did not (OR, 0.62; 95% CI, 0.28–1.37).
Systemic vascular resistance was inversely associated with hyperdynamic LVEF (OR, 0.79; 95% CI, 0.58–0.95), while depressed LVEF correlated with age, frailty, and ischemic heart disease.

Structured PICO

P

Population

1,014 ICU patients who received a transthoracic echocardiogram within 7 days of sepsis, median age 62 (IQR 47-72), mostly respiratory infections (54.9%).

O

Outcome

90-day mortalityhard clinical

In septic ICU patients, a hyperdynamic LVEF (>70%) is independently associated with significantly higher 90-day mortality, likely reflecting severe unmitigated vasoplegia.

Implication

Should not yet change practice; leaves open whether vasoplegia-targeted care in hyperdynamic LVEF improves septic survival.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Chotalia et al. (2021) studied this question.

synapsesocial.com/papers/6a807dd28ae067bd3b703469 https://doi.org/10.1097/ccm.0000000000005315

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Hyperdynamic Left Ventricular Ejection Fraction in ICU Patients With Sepsis

Key Points

Structured PICO

Implication

Discussion

Cite This Study

Hyperdynamic Left Ventricular Ejection Fraction in ICU Patients With Sepsis

Key Points

Structured PICO

Implication

Discussion

Cite This Study

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