An early echocardiographic findings in septic cardiomyopathy: A pilot study.
Academic Emergency Medicine
Background: Septic cardiomyopathy (SC) has been recognized for 40 years but the prognostic implications are unclear. Results of prior echocardiography studies are conflicting but limited by performance in the ICU with initial scans performed up to 48 hours after presentation. Cardiac function may change during this time in response to treatment or disease progression. Determination of cardiac function at presentation may inform prognosis or treatment decisions. The goal of this pilot study was to describe echocardiographic parameters of cardiac function in the first 24 hours of admission for sepsis. Methods: Prospective observational trial at an urban ED with >100,000 annual visits. Subjects were eligible for inclusion if being treated for suspected infection plus either systolic blood pressure < 90 or lactate >2mmol/L. A convenience sample was enrolled when a study sonographer was available. Beside Echocardiograms (BE) were performed at presentation, 3 and 24 hours after arrival. Subjects receiving >1L of IV fluid (IVF) prior to BE1 were excluded. Parameters of left-ventricular (LV) function (ejection fraction (EF), diastolic function, and longitudinal strain) and clinical data were collected. Results: We enrolled 35 patients; 7 were excluded for low-quality BE data, leaving 28 for analysis. Average age was 62, 45% were male, 34% had end-stage renal disease, and 28% had heart failure. Mortality was 24%, with 26% intubated, 33% on vasopressors and 36% admitted to the ICU. Average IVF administered was 2.2 L in the ED and 4.3 L in the first 24 hours. Longitudinal strain at presentation was worse in non-survivors compared to survivors (-8.0 vs - 14.5, p=0.03) and decline in 24 hours was strongly correlated with IVF volume given (R= -0.74, p=0.09). At presentation, E/e’ was greater (medial 20.1 vs 15.7 (p=0.4), lateral 13.9 vs 13.1 (p=0.1), and average 16.4 vs 14.8 (p=0.7)) and LVEF was lower in non-survivors (32.5% vs 41.4%, p=0.1). Conclusion: In this pilot study, impaired longitudinal strain at presentation was associated with increased mortality in septic ED patients, and decline thereof was associated with volume of IVF given. Non-significant differences in diastolic function and LVEF were also found. Larger studies are needed to confirm our findings and further elucidate the relationship between LV function and outcomes in sepsis.
Ehrman RR, Favot M, Sullivan A, Malik A, Harrison N, et al. An early echocardiographic findings in septic cardiomyopathy: A pilot study. Acad Emerg Med 2019; 26: S293-S294.