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Epidemiology of right ventricular systolic dysfunction in patients with sepsis and septic shock in the emergency department

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Abstract

We evaluated whether in sepsis, right ventricular (RV) systolic dysfunction (RVSD) predicts short-term all-cause mortality, independently to left ventricular (LV) global longitudinal peak systolic strain (GLS). This is a prospective observational study. We enrolled 252 septic patients (40% with shock) between October 2012 and July 2018 among those admitted to High-Dependency Unit. By echocardiography within 24 h from the admission (T1), RVSD was defined as Tricuspid Annular Plane Systolic Excursion (TAPSE) < 16 mm, while left ventricular systolic dysfunction (LVSD) was defined by bi-dimensional speckle-tracking-based global longitudinal peak systolic strain (GLS) > -14%. We assessed all-cause mortality at day-7 and at day-28 from admission. Mortality rate was 14% by day-7 and 26% by day-28 follow-up. RVSD was found in 85 patients (34%), was isolated in 29% (25/85) and coexisted with LVSD in 71% (60/85) patients. LVSD was present in 63% of patients (159/252), and was isolated in 99 patients. Day-7 mortality rate was twofold higher in the presence of RVSD (20% vs 11%), without reaching the statistical significance (p = 0.097). By day-28, mortality rate was as high as 44% with and 23% without RVSD (p = 0.001). In a Cox survival analysis, RVSD predicted higher mortality rate by day-28 follow-up (RR 2.43, 95% CI 1.47–4.00, p = 0.001), independent to shock and in addition to LVSD. In sepsis, RVSD predicted all-cause mortality by day-28 follow-up, independent to LVSD.

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Authors and Affiliations

  1. High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy

    Francesca Innocenti, Valerio Teodoro Stefanone, Chiara Donnini, Federico D’Argenzio, Marco Cigana, Irene Tassinari & Riccardo Pini

  2. Transplant Cardiosurgery Unit, Department of Cardiosurgery and Transplant, University Hospital Monaldi-Cotugno-CTO, Naples, Italy

    Vittorio Palmieri

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  1. Francesca Innocenti
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Correspondence to Francesca Innocenti.

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The study protocol was approved by the “Toscana—Area vasta—Centro” inter-institutional ethic committee (registration number OSS.13.031) and was conducted in accordance with the Helsinki Declaration of 1964 (revised 2008).

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Innocenti, F., Palmieri, V., Stefanone, V.T. et al. Epidemiology of right ventricular systolic dysfunction in patients with sepsis and septic shock in the emergency department. Intern Emerg Med 15, 1281–1289 (2020). https://doi.org/10.1007/s11739-020-02325-z

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