Clinical Investigations

Hyperdynamic Left Ventricular Ejection Fraction in ICU Patients With Sepsis

Chotalia, Minesh BMBCh^1,2; Ali, Muzzammil MRCP²; Hebballi, Ravi FRCA²; Singh, Harjot FRCA²; Parekh, Dhruv PhD^1,2; Bangash, Mansoor N. PhD^1,2; Patel, Jaimin M. PhD^1,2

Author Information

¹ Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom.

² Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.

Drs. Parekh, Bangash, and Patel are joint senior authors.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Drs. Chotalia and Ali collected the data and performed the analysis. Drs. Chotalia, Parekh, Bangash, and Patel conceived and designed the analysis and wrote the article. Drs. Hebballi and Singh revised the article for important intellectual content. All authors have read and approved the final article.

Dr. Parekh received support for article research from the National Institute for Health Research. Dr. Bangash received funding from the Intensive Care Society and a regional research scholarship fund. The remaining authors have disclosed that they do not have any potential conflicts of interest.

This work was performed at Birmingham Acute Care Research Group, University of Birmingham, Mindelsohn Way, Birmingham, United Kingdom.

For information regarding this article, E-mail: [email protected]

Critical Care Medicine 50(5):p 770-779, May 2022. | DOI: 10.1097/CCM.0000000000005315

Abstract

OBJECTIVES:

To evaluate the cause and prognosis of hyperdynamic left ventricular ejection fraction in critically ill patients with sepsis.

DESIGN:

Retrospective, single-center cohort study.

SETTING:

University Hospital ICU, Birmingham, United Kingdom.

PATIENTS:

ICU patients who received a transthoracic echocardiogram within 7 days of sepsis between April 2016 and December 2019.

INTERVENTION:

None.

MEASUREMENTS AND MAIN RESULTS:

The 90-day mortality rates of normal (55–70%), depressed (< 55%), and hyperdynamic left ventricular ejection fraction (> 70%) were compared. Multivariate logistic regression analysis was performed to determine the association of left ventricular ejection fraction phenotypes with mortality and the association of clinical variables with left ventricular ejection fraction phenotypes. One thousand fourteen patients met inclusion criteria and were 62 years old (interquartile range, 47–72), with mostly respiratory infections (n = 557; 54.9%). Ninety-day mortality was 32.1% (n = 325). Patients with hyperdynamic left ventricular ejection fraction had a higher mortality than depressed and normal left ventricular ejection fraction cohorts (58.9% [n = 103] vs 34.0% [n = 55] vs 24.7% [n = 167]; p < 0.0001, respectively). After multivariate logistic regression, hyperdynamic left ventricular ejection fraction was independently associated with mortality (odds ratio, 3.90 [2.09–7.40]), whereas depressed left ventricular ejection fraction did not (odds ratio, 0.62 [0.28–1.37]). Systemic vascular resistance was inversely associated with hyperdynamic left ventricular ejection fraction (odds ratio, 0.79 [0.58–0.95]), and age, frailty, and ischemic heart disease were associated with depressed left ventricular ejection fraction.

CONCLUSIONS:

Hyperdynamic left ventricular ejection fraction was associated with mortality in septic ICU patients and may reflect unmitigated vasoplegia from sepsis. Depressed left ventricular ejection fraction was not associated with mortality but was associated with cardiovascular disease.