Diagnostic and prognostic value of speckle tracking echocardiography for right ventricular dysfunction in sepsis: a retrospective observational study.

BACKGROUND

Right ventricular dysfunction (RVD) is increasingly recognized as a prognostic factor in sepsis. The diagnostic accuracy and prognosis value of speckle tracking echocardiography (STE)-derived parameters such as right ventricular longitudinal strain (RVLS) and tissue motion annular displacement (RVTMAD) remain inadequately defined in critically ill patient.

METHODS

This retrospective observational study included patients admitted to the intensive care unit (ICU) with sepsis or septic shock from March 2019 to November 2021. Transthoracic echocardiography was performed within 24 h of ICU admission. RVLS and RVTMAD were measured offline using STE. The diagnostic performance of these parameters for RVD was evaluated using ROC curve analysis, and their association with mortality was assessed using Cox regression models.

RESULTS

Among 159 enrolled patients, 57 (35.8%) were diagnosed with RVD. Patients with RVD exhibited significantly higher (less negative) RVLS (P < 0.05). RVTMADmid and RVTMAD% demonstrated the highest diagnostic accuracy for RVD, with AUROC values of 0.913 (95% CI: 0.866-0.960) and 0.917 (95% CI: 0.874-0.960), respectively. Patients with RVTMADmid < 10.95 mm or RVTMAD% < 16.70%, had higher in-hospital mortality. Right ventricular free-wall longitudinal strain (RVFWLS) ≥ - 18.85% was associated with higher in-hospital and 28-day mortality. In the Cox proportional hazards regression analysis, the SOFA score emerged as the sole independent predictor of in-hospital mortality.

CONCLUSION

RVTMAD is a simple and reproducible STE-derived parameter with excellent diagnostic performance for identifying RVD in sepsis. It may serve as a valuable complement to conventional echocardiographic measures, particularly when image quality is suboptimal.