Long-term outcomes of abnormal global longitudinal left ventricular strain during sepsis: A retrospective cohort study.

BACKGROUND

Sepsis survivors often face long-term cardiovascular complications, including major adverse cardiovascular events (MACE), potentially linked to septic cardiomyopathy. Left ventricular global longitudinal strain (LV GLS) is a sensitive marker of cardiac dysfunction and a predictor of adverse outcomes. This study aimed to evaluate whether cardiac dysfunction measured by LV GLS is an independent predictor of MACE in septic patients.

METHODS

This multicenter retrospective open cohort study included 439 patients hospitalized with sepsis or septic shock between 2018 and 2022. LV systolic function was assessed using LV GLS and Left Ventricular Ejection Fraction (LVEF) within seven days of admission. Patients were followed until July 2024. Restricted cubic spline Cox regression models examined non-linear associations between LV GLS, LVEF, and MACE. Additionally, Cox regression models adjusted for demographics, comorbidities, laboratory values, and sepsis severity markers evaluated whether LV systolic dysfunction, defined as high LV GLS (> -16) or low LVEF, were predictors of MACE.

RESULTS

During the study period, 439 septic patients were included, totaling 595 patient-years of follow-up. Among them, 254 experienced MACE. LV GLS exhibited a non-linear association with MACE, with values between -23 and - 16 associated with the lowest risk. High LV GLS was independently associated with MACE (unadjusted HR: 1.4 [95% CI: 1.07, 1.8; p = 0.01]; adjusted HR 1.38 [95% CI: 1.01, 1.9; p = 0.04]). In contrast, low LVEF was not associated with MACE (unadjusted HR 1.2 [95% CI: 0.9, 1.5; p = 0.2]; adjusted HR 1.03 [95% CI: 0.73, 1.45; p = 0.8]).

CONCLUSIONS

LV GLS was an independent predictor of MACE in septic patients, whereas LVEF did not show a significant association. These findings suggest that LV GLS may be a valuable biomarker for long-term cardiovascular risk stratification in this population.