Hyperdynamic Left Ventricular Ejection Fraction as a Predictor of Mortality in Intensive Care Unit Patients with Septic Shock

Abstract

Abstract Background A hyperdynamic left ventricle (ejection fraction ≥ 70%) seen on stress radionuclide myocardial perfusion imaging bears strong association with diastolic dysfunction and is therefore a marker of heart failure with preserved ejection fraction in appropriate clinical setting. Objective Evaluation of the cause and prognosis of hyperdynamic left ventricular ejection fraction in critically ill patients with sepsis. Patients and Methods A total of 235 patients diagnosed as septic shock admitted intensive care unit were enrolled. Patients were admitted to the ICU with a source of infection, diagnosed as sepsis using the Sequential Organ Failure Assessment score (SOFA). The score was calculated at admission and every 24 hours until discharge, using the worst parameters measured during the prior 24 hours. Besides tracing and promptly managing hemodynamic instability signs in patients with septic shock who are included in the study, as per Surviving Sepsis Campaign (SSC) recommendations. Data of past medical history and associated comorbidities were collected. Serum lactate level was measured on daily base. TTE was performed by myself or by the cardiologist (accredited from EMSE; the Egyptian Medical Society of Echocardiography). Results As regard 28 days mortality distribution; cases in our study were divided into 88 died and 147 living cases. As regard hyper-dynamic EF, our study reported statistically significant higher frequency of hyper-dynamic EF in died group 46 (52.3%) vs. 16 (10.9%) with higher Odds ratio [4.822 “1.467-8.852”]. Multivariate analysis revealed that the most significant predictors of mortality were old age 62.00 ± 17.90 vs. 54.14 ± 15.77 years, low MAP 40.70 ± 7.98 vs. 47.48 ± 4.70 mm/hg, high SOFA score 18.08 ± 1.95 vs. 14.27 ± 1.59, high serum lactate 4.52 ± 2.45 vs. 2.13 ± 1.06 mg/dl. As regard gender; there was a statistically significant higher frequency of male in died comparing to living group. Conclusion Hyperdynamic left ventricular ejection fraction has a significant prognostic value in critically ill patients with sepsis. It is a promising echocardiographic parameter in early detection of sepsis-induced cardiomyopathy or cardiovascular dysfunction.