Department of Critical Care Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
J Korean Med Sci. 2020 Feb 3;35(4):e24. doi: 10.3346/jkms.2020.35.e24.
The impact of myocardial damage on the prognosis of patients with septic shock is not clearly elucidated because complex hemodynamic changes in sepsis obscure the direct relationship. We evaluated left ventricular (LV) conditions that reflect myocardial damage independently from hemodynamic changes in septic shock and their influence on the prognosis of patients.
We retrospectively enrolled 208 adult patients who were admitted to the intensive care unit and underwent echocardiography within 7 days from the diagnosis of septic shock. Patients who were previously diagnosed with structural heart disease or coronary artery disease were excluded. Left ventricular ejection fraction (LVEF) was divided into four categories: normal, ≥ 50%; mild, ≥ 40%; moderate, ≥ 30%; and severe dysfunction, < 30%. Wall motion impairment was categorized into the following patterns: normal, diffuse, ballooning, and focal.
There were 141 patients with normal LVEF. Among patients with impaired LV wall motion, the diffuse pattern was the most common (34 patients), followed by the ballooning pattern (26 patients). Finally, 102 patients died, and in-hospital mortality was significantly higher in patients with severe LV systolic dysfunction (hazard ratio [HR], 1.97; 95% confidence interval [CI], 1.04-3.75; = 0.039) and in patients with diffuse pattern of LV wall motion impairment (HR, 2.28; 95% CI, 1.19-4.36; = 0.013) than in those with a normal LV systolic function.
Severe LV systolic dysfunction and diffuse pattern of LV wall motion impairment significantly affected in-hospital mortality in patients with septic shock. Conventional echocardiographic evaluation provides adequate information on the development of myocardial damage and accurately predicts the prognosis of patients with septic shock.
心肌损伤对感染性休克患者预后的影响尚不清楚，因为脓毒症复杂的血流动力学变化掩盖了直接关系。我们评估了独立于感染性休克血流动力学变化反映心肌损伤的左心室（LV）情况及其对患者预后的影响。
我们回顾性纳入了 208 名成年患者，这些患者在感染性休克确诊后 7 天内行超声心动图检查。排除了先前诊断为结构性心脏病或冠状动脉疾病的患者。左心室射血分数（LVEF）分为四组：正常，≥50%；轻度，≥40%；中度，≥30%；重度功能障碍，＜30%。LV 壁运动障碍分为以下模式：正常、弥漫性、气球样变和局灶性。
141 名患者 LVEF 正常。在 LV 壁运动障碍患者中，弥漫性模式最常见（34 例），其次是气球样变模式（26 例）。最后，有 102 名患者死亡，严重 LV 收缩功能障碍患者的院内死亡率明显更高（危险比[HR]，1.97；95%置信区间[CI]，1.04-3.75；P=0.039），LV 壁运动障碍弥漫性模式患者的院内死亡率也明显更高（HR，2.28；95%CI，1.19-4.36；P=0.013）。
严重的 LV 收缩功能障碍和 LV 壁运动障碍弥漫性模式显著影响感染性休克患者的院内死亡率。常规超声心动图评估可提供充分的心肌损伤发展信息，并准确预测感染性休克患者的预后。
