1179: NOVEL ECHOCARDIOGRAPHIC PHENOTYPES FOR ASSESSMENT OF SYSTOLIC FUNCTION IN PATIENTS WITH SEPSIS

Abstract

Introduction: LVEF in often influenced by loading conditions compared to mitral annular peak systolic velocity (MASV). Therefore, the clinical utility of LVEF under varying physiologic states especially in septic shock patients is unclear. We plan to identify distinct echocardiographic phenotypes using systolic wave (s’) obtained with Tissue Doppler Imaging (TDI) to assess left ventricle (LV) systolic function. Methods: We conducted a retrospective study between 2011 – 2020 of all adult patients admitted to the medical intensive care unit (MICU) with sepsis and septic shock that underwent a transthoracic echocardiogram (TTE) within 72 hours of admission. We excluded any patient without LVEF or mitral annular peak systolic velocity (MASV) measurements. Patients were divided into 4 novel phenotypes based on their LVEF and average MASV (α, β, γ, and δ). α = LVEF ≥ 55% & MASV average ≥ 8.5 cm/sec, β = LVEF ≥ 55% & MASV average < 8.5 cm/sec, γ = LVEF < 55% & MASV average ≥ 8. 5 cm/sec and finally δ = LVEF < 55 & MASV average < 8.5 cm/sec. The primary outcome was to identify the derived phenotype (α, β, γ, and δ) frequency and its association with in-hospital mortality. Results: Total of 3120 patients were admitted with sepsis or septic shock during the study period, of which 2481 met the inclusion criteria. Of the 4 derived phenotypes, the α phenotype was the most common (n =1,063; 43%) and included patients with lowest median age 43 (34 - 51) and had more liver dysfunction (n= 231, 22%); β phenotype (n = 599; 24%) had older patients 51 (42 - 60) and more chronic illness (Diabetes and chronic obstructive pulmonary disease); in the γ phenotype (n = 266; 11%), patients had the highest acute physiology score 73 (53 - 95); and in the δ phenotype (n = 593; 24%), patients had highest Mitral E/e′ ratio (12.6) and lowest TAPSE measurement (1.6). The ICU mortality was 28% for the α phenotype; 36% for the β phenotype; 29% for the γ phenotype; and 35% for the δ phenotype. Conclusions: In this analysis of systolic function among patients with sepsis, β (LVEF ≥ 55% & MASV < 8.5 cm/sec) and δ (LVEF < 55 & MASV < 8.5 cm/sec) phenotypes were associated with higher mortality. Further research is needed to establish the utility of these distinct LV systolic function phenotypes in outcomes of patient with sepsis and septic shock.