Types of Septic Cardiomyopathy: Prognosis and Influencing Factors - A Clinical Study

Abstract

Objective

To explore the prognostic outcomes associated with different types of septic cardiomyopathy and analyze the factors that exert an influence on these outcomes.

Methods

The data collected within 24 hours of ICU admission included cardiac troponin I (cTnI), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP); SOFA (sequential organ failure assessment) scores, and the proportion of vasopressor use. Based on echocardiographic outcomes, septic cardiomyopathy was categorized into left ventricular (LV) systolic dysfunction, LV diastolic dysfunction, and right ventricular (RV) systolic dysfunction. Differences between the mortality and survival groups, as well as between each cardiomyopathy subgroup and the non-cardiomyopathy group were compared, to explore the influencing factors of cardiomyopathy.

Results

A cohort of 184 patients were included in this study, with LV diastolic dysfunction having the highest incidence rate (43.5%). The mortality group had significantly higher SOFA scores, vasopressor use, and cTnI levels compared to the survival group; the survival group had better LV diastolic function than the mortality group (p < 0.05 for all). In contrast to the non-cardiomyopathy group, each subgroup within the cardiomyopathy category exhibited elevated levels of cTnI. The subgroup with left ventricular diastolic dysfunction demonstrated a higher prevalence of advanced age, hypertension, diabetes mellitus, coronary artery disease, and an increased mortality rate; the RV systolic dysfunction subgroup had higher SOFA scores and NT-proBNP levels, and a higher mortality rate (P < 0.05 for all); the LV systolic dysfunction subgroup had a similar mortality rate (P > 0.05).

Conclusion

Patients with advanced age, hypertension, diabetes mellitus, or coronary artery disease are more prone to develop LV diastolic dysfunction type of cardiomyopathy; cardiomyopathy subgroups had higher levels of cTnI. The RV systolic dysfunction cardiomyopathy subgroup had higher SOFA scores and NT-proBNP levels. The occurrence of RV systolic dysfunction in patients with sepsis significantly increased the mortality rate.

Keywords:

• cardiac function
• echocardiography
• influencing factors
• prognosis
• sepsis
• septic cardiomyopathy

Abbreviations

LVDD, Left ventricular end-diastolic diameter; LVEF, left ventricular ejection fraction; E, early diastolic flow peak velocity of the mitral valve; A, diastolic flow peak velocity of the mitral valve; e’, early diastolic peak velocity of mitral valve annulus; LV-Sm, left ventricular systolic mitral annular velocity; RV-Sm, and right ventricular systolic tricuspid annular velocity; cTnI, Cardiac troponin I; NT-proBNP, N-terminal probrain natriuretic peptide; SOFA, Sepsis-related organ failure assessment; PCT, Procalcitonin; ICU, Intensive care unit; ELISA, Enzyme linked immunosorbent assay; RV, Right ventricular; LV, Left ventricular.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author Xiu-Ming Xi upon reasonable request.

Ethics Approval and Consent to Participate

This study was conducted with approval from the Ethics Committee of Beijing Electric Power Hospital. This study was conducted in accordance with the declaration of Helsinki. Written informed consent was obtained from all participants.

Acknowledgments

We would like to acknowledge the hard and dedicated work of all the staff who implemented the intervention and evaluation components of the study.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

This work was supported by Scientific Research Project of Jiangsu Commission of Health of the People’s Republic of China (grant number: Z2020055), and the Ministry of Science and Technology of the People’s Republic of China (grant number: 2012BAI11B05).