Epidemiology of right ventricular systolic dysfunction in patients with sepsis and septic shock in the emergency departm
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Epidemiology of right ventricular systolic dysfunction in patients with sepsis and septic shock in the emergency department Francesca Innocenti1 · Vittorio Palmieri2 · Valerio Teodoro Stefanone1 · Chiara Donnini1 · Federico D’Argenzio1 · Marco Cigana1 · Irene Tassinari1 · Riccardo Pini1 Received: 12 December 2019 / Accepted: 24 March 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract We evaluated whether in sepsis, right ventricular (RV) systolic dysfunction (RVSD) predicts short-term all-cause mortality, independently to left ventricular (LV) global longitudinal peak systolic strain (GLS). This is a prospective observational study. We enrolled 252 septic patients (40% with shock) between October 2012 and July 2018 among those admitted to HighDependency Unit. By echocardiography within 24 h from the admission (T1), RVSD was defined as Tricuspid Annular Plane Systolic Excursion (TAPSE) -14%. We assessed all-cause mortality at day-7 and at day-28 from admission. Mortality rate was 14% by day-7 and 26% by day-28 follow-up. RVSD was found in 85 patients (34%), was isolated in 29% (25/85) and coexisted with LVSD in 71% (60/85) patients. LVSD was present in 63% of patients (159/252), and was isolated in 99 patients. Day-7 mortality rate was twofold higher in the presence of RVSD (20% vs 11%), without reaching the statistical significance (p = 0.097). By day-28, mortality rate was as high as 44% with and 23% without RVSD (p = 0.001). In a Cox survival analysis, RVSD predicted higher mortality rate by day-28 follow-up (RR 2.43, 95% CI 1.47–4.00, p = 0.001), independent to shock and in addition to LVSD. In sepsis, RVSD predicted all-cause mortality by day-28 follow-up, independent to LVSD. Keywords Sepsis · Right ventricular dysfunction · Left ventricular dysfunction · Prognosis
Introduction In patients with sepsis, myocardial dysfunction, or septic cardiomyopathy, has been investigated with a focus on left ventricular systolic dysfunction (LVSD) [1–10]. The prevalence and prognostic impact of right ventricular systolic dysfunction (RVSD) and its relationship with the presence of LVSD is not well characterized. Sepsis-related pathophysiological mechanisms are systemic and include coronary hypoperfusion due to prolonged hypotension, circulating * Francesca Innocenti [email protected] 1
High‑Dependency Unit, Department of Clinical and Experimental Medicine, Azienda OspedalieroUniversitaria Careggi, Lg. Brambilla 3, 50134 Florence, Italy
Transplant Cardiosurgery Unit, Department of Cardiosurgery and Transplant, University Hospital Monaldi-Cotugno-CTO, Naples, Italy
2
cytokines (TNF-a, IL-1b), lysozyme-c, endothelin-1 with direct inhibition of myocardial contractility and induced mitochondrial dysfunction and apoptosis [11–13]. Therefore, it is expected that sepsis-related cardiac dysfunction may involve both ventricles. Nevertheless, the extent to which RVSD affects prognosis in sepsis has not been extensively studied [14]. In addition, patients with sepsis may have abnormal
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