Abstract
BackgroundEchocardiographic myocardial dysfunction is reported commonly in sepsis and septic shock, but there are limited data on sepsis-related right ventricular dysfunction. This study sought to evaluate the association of right ventricular dysfunction with clinical outcomes in patients with severe sepsis and septic shock.MethodsHistorical cohort study of adult patients admitted to all intensive care units at the Mayo Clinic from January 1, 2007 through December 31, 2014 for severe sepsis and septic shock, who had an echocardiogram performed within 72 h of admission. Patients with prior heart failure, cor-pulmonale, pulmonary hypertension and valvular disease were excluded. Right ventricular dysfunction was defined by the American Society of Echocardiography criteria. Outcomes included 1-year survival, in-hospital mortality and length of stay.ResultsRight ventricular dysfunction was present in 214 (55%) of 388 patients who met the inclusion criteria—isolated right ventricular dysfunction was seen in 100 (47%) and combined right and left ventricular dysfunction in 114 (53%). The baseline characteristics were similar between cohorts except for the higher mechanical ventilation use in patients with isolated right ventricular dysfunction. Echocardiographic findings demonstrated lower right ventricular and tricuspid valve velocities in patients with right ventricular dysfunction and lower left ventricular ejection fraction and increased mitral E/e′ ratios in patients with combined right and left ventricular dysfunction. After adjustment for age, comorbidity, illness severity, septic shock and use of mechanical ventilation, isolated right ventricular dysfunction was independently associated with worse 1-year survival—hazard ratio 1.6 [95% confidence interval 1.2–2.1; p = 0.002) in patients with sepsis and septic shock.ConclusionsIsolated right ventricular dysfunction is seen commonly in sepsis and septic shock and is associated with worse long-term survival.
Highlights
Echocardiographic myocardial dysfunction is reported commonly in sepsis and septic shock, but there are limited data on sepsis-related right ventricular dysfunction
Of 1757 patients with severe sepsis and septic shock admitted to the intensive care units (ICU) at Mayo Clinic from 2007 to 2014, 388 (22.1%) met the eligibility criteria (Fig. 1)
The patients were divided into three cohorts—isolated right ventricular (RV) dysfunction (100; 25.8%), combined RV and Left ventricular (LV) dysfunction (114; 29.4%) and no RV dysfunction (174; 44.8%)
Summary
Echocardiographic myocardial dysfunction is reported commonly in sepsis and septic shock, but there are limited data on sepsis-related right ventricular dysfunction. This study sought to evaluate the association of right ventricular dysfunction with clinical outcomes in patients with severe sepsis and septic shock. Sepsis-related myocardial dysfunction is frequently seen in patients with severe sepsis and septic shock [1,2,3]. Left ventricular (LV) systolic and diastolic dysfunction have been extensively studied in these patients and have demonstrated a variable correlation with clinical outcomes [1, 2]. The evaluation and clinical consequences of right ventricular (RV) dysfunction in septic patients has received lesser attention [4]. RV dysfunction is reported in 30–60% of all septic patients and is frequently associated with concomitant LV dysfunction [6, 7]. With the increasing use and evolution of echocardiographic methods for assessment of RV function, such
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