Online Clinical Investigations

Long-Term Implications of Abnormal Left Ventricular Strain During Sepsis

Beesley, Sarah J. MD, MS^1,2; Sorensen, Jeff MStat¹; Walkey, Allan J. MD³; Tonna, Joseph E. MD, MS^4,5; Lanspa, Michael J. MD, MS¹; Hirshberg, Ellie MD^1,2,6; Grissom, Colin K. MD^1,2; Horne, Benjamin D. PhD, MStat, MPH^7,8; Burk, Rebecca MD^1,2; Abraham, Theodore P. MD⁹; Paine, Robert MD²; Brown, Samuel M. MD, MS, FCCM, FASE^1,2

Author Information

¹ Division of Pulmonary, Department of Medicine, Intermountain Medical Center, Salt Lake City, UT.

² Division of Pulmonary, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT.

³ Division of Pulmonary, Department of Medicine, Boston University, Boston, MA.

⁴ Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, UT.

⁵ Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.

⁶ Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.

⁷ Intermountain Medical Center Heart Institute, Intermountain Healthcare, Salt Lake City, UT.

⁸ Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA.

⁹ Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA.

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).

The Intermountain Institutional Review Board approved this study with waiver of informed consent.

Drs Beesley, Tonna, Paine, Grissom, and Brown designed the study. Drs. Beesley, Sorensen, Tonna, Paine, and Brown analyzed and interpreted the data. Dr. Beesley drafted the report, and all other authors revised it. All authors gave final approval of the report to be published.

Supported (in part or in full) by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001067.

Dr. Walkey received funding from UptoDate. Dr. Tonna’s institution received funding from National Heart, Lung, and Blood Institute (NHLBI), National Center for Advancing Translational Sciences, and LivaNova; he received funding from Philips Healthcare; he received support for article research from National Institutes of Health; and he was supported by a career development award (K23HL141596) from the NHLBI of the National Institutes of Health. Dr. Burk received funding from Intermountain Research and Medical Foundation. Dr. Paine’s institution received funding from NHLBI and the Department of Veterans Affairs. The remaining authors have disclosed that they do not have any potential conflicts of interest.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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

Critical Care Medicine 49(4):p e444-e453, April 2021. | DOI: 10.1097/CCM.0000000000004886

Abstract

Objectives:

Septic cardiomyopathy develops frequently in patients with sepsis and likely increases short-term mortality. However, whether septic cardiomyopathy is associated with long-term outcomes after sepsis is unknown. We investigated whether septic patients with septic cardiomyopathy have worse long-term outcomes than septic patients without septic cardiomyopathy.

Design:

Retrospective cohort study.

SETTING:

Adult ICU.

PATIENTS:

Adult ICU patients with sepsis.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Left ventricular global longitudinal systolic strain was our primary measure of septic cardiomyopathy. We employed a suite of multivariable survival analyses to explore linear and nonlinear associations between left ventricular global longitudinal systolic strain and major adverse cardiovascular events, which included death, stroke, and myocardial infarction. Our primary outcome was major adverse cardiovascular event through 24 months after ICU discharge. Among 290 study patients, median left ventricular global longitudinal systolic strain was –16.8% (interquartile range, –20.4% to –12.6%), and 38.3% of patients (n = 111) experienced a major adverse cardiovascular event within 24 months after discharge. On our primary, linear analysis, there was a trend (p = 0.08) toward association between left ventricular global longitudinal systolic strain and major adverse cardiovascular event (odds ratio, 1.03; CI, < 1 to 1.07). On our nonlinear analysis, the association was highly significant (p < 0.001) with both high and low left ventricular global longitudinal systolic strain associated with major adverse cardiovascular event among patients with pre-existing cardiac disease. This association was pronounced among patients who were younger (age < 65 yr) and had Charlson Comorbidity Index greater than 5.

Conclusions:

Among patients with sepsis and pre-existing cardiac disease who survived to ICU discharge, left ventricular global longitudinal systolic strain demonstrated a U-shaped association with cardiovascular outcomes through 24 months. The relationship was especially strong among younger patients with more comorbidities. These observations are likely of use to design of future trials.