Quantitative assessment and prognostic value of myocardial work indices in sepsis-induced cardiomyopathy patients with left ventricular systolic dysfunction.

OBJECTIVE

This study investigates the value of myocardial work indices (MWI) in quantitatively assessing left ventricular systolic dysfunction (LVSD) in patients with sepsis-induced cardiomyopathy (SICM-LVSD) and in predicting outcomes in sepsis.

METHODS

In this prospective cohort study, 180 patients were categorized into sepsis and SICM groups based on echocardiographic findings. The patients further divided into survival and event groups based on the 28 days prognosis. The study assessed the diagnostic and prognostic value of MWI and various conventional echocardiographic parameters, including global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE), global longitudinal strain (GLS), and left ventricular ejection fraction(LVEF). Univariate and multivariate logistic regression analyses were performed to investigate the diagnostic value of MWI parameters for SICM-LVSD and their prognostic efficacy.

RESULTS

MWI were significantly impaired in the SICM and event groups, with GWI, GCW, and GWE being significantly lower, while GWW was higher in the SICM compared to the sepsis group (all P < 0.01). GLS demonstrated the highest diagnostic value for SICM-LVSD (AUC = 0.81), followed by GWI and GCW (AUC = 0.77 for both). In terms of prognosis, GWI, GCW, GLS, and GWE were the most effective predictors of adverse events (AUC values of 0.75, 0.74, 0.72, and 0.70, respectively).

CONCLUSION

MWI can accurately assess LVSD in patients with SICM. GLS, GWI, and GCW demonstrate high diagnostic efficacy. While GWI, GCW, and GWE provide superior prognostic value for 28-day outcomes compared to traditional measures like LVEF. MWI represents a promising new echocardiographic approach that integrates myocardial strain with afterload, offering a more physiologic evaluation of myocardial performance.