Hyperdynamic left ventricular ejection fraction as a predictor of mortality in intensive care unit patients with septic shock.

BACKGROUND

A hyperdynamic left ventricle (ejection fraction (EF) ≥70 %) on stress imaging is closely linked to diastolic dysfunction and may indicate heart failure with preserved EF (HFpEF) in the right clinical context.

OBJECTIVES

To investigate the underlying causes and prognostic implications of hyperdynamic left ventricular ejection fraction (HDLVEF) in critically ill patients diagnosed with sepsis.

METHODS

A total of 235 patients diagnosed with septic shock and admitted to the intensive care unit were included in this study. Diagnosis of sepsis was established based on the sequential organ failure assessment (SOFA) score, which was calculated upon admission and updated every 24 h using the worst values from the prior day. Transthoracic echocardiography (TTE) was performed either by the principal investigator or a certified cardiologist accredited by the Egyptian Medical Society of Echocardiography (EMSE).

RESULTS

Among the 235 patients, 88 (37.4 %) died within 28 days, while 147 (62.6 %) survived. Hyperdynamic EF was significantly more prevalent in the deceased group compared to survivors, with an odds ratio of 4.822 (95 % CI: 1.467-8.852), indicating a strong association with mortality. Multivariate analysis identified several independent predictors of mortality, including older age, lower mean arterial pressure, higher SOFA scores, and elevated serum lactate levels. Additionally, the mortality rate was significantly higher among male patients.

CONCLUSION

HDLVEF holds significant prognostic value in patients with sepsis in critical care. It may serve as a valuable early echocardiographic marker of sepsis-induced cardiomyopathy or cardiovascular dysfunction, potentially aiding in risk assessment and early therapeutic decisions.

TRIAL REGISTRATION: The trial was registered before patient enrolment at ClinicalTrials.gov (ID/ NCT06993948).