High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy.
Transplant Cardiosurgery Unit, Department of Cardiosurgery and Transplant, University Hospital Monaldi-Cotugno-CTO, Naples, Italy.
Intern Emerg Med. 2020 Oct;15(7):1281-1289. doi: 10.1007/s11739-020-02325-z. Epub 2020 Apr 11.
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.
我们评估了在败血症中，右心室（RV）收缩功能障碍（RVSD）是否独立于左心室（LV）整体纵向峰值收缩应变（GLS）预测短期全因死亡率。这是一项前瞻性观察研究。我们在 2012 年 10 月至 2018 年 7 月期间，从高依赖病房收治的 252 例败血症患者（40%有休克）中纳入了这些患者。通过入院后 24 小时内的超声心动图（T1），RVSD 定义为三尖瓣环平面收缩期位移（TAPSE）<16mm，而左心室收缩功能障碍（LVSD）定义为二维斑点追踪技术基于的整体纵向峰值收缩应变（GLS）>−14%。我们在入院后第 7 天和第 28 天评估了全因死亡率。第 7 天的死亡率为 14%，第 28 天的死亡率为 26%。85 例患者（34%）存在 RVSD，29%（25/85）为孤立性 RVSD，71%（60/85）患者同时存在 LVSD。252 例患者中有 63%（159/252）存在 LVSD，其中 99 例为孤立性 LVSD。存在 RVSD 的患者第 7 天死亡率是无 RVSD 患者的两倍（20%对 11%），但未达到统计学意义（p=0.097）。第 28 天，死亡率高达 44%，有 RVSD，而无 RVSD 的死亡率为 23%（p=0.001）。在 Cox 生存分析中，RVSD 预测第 28 天随访时死亡率更高（RR 2.43，95%CI 1.47-4.00，p=0.001），独立于休克，且独立于 LVSD。在败血症中，RVSD 预测第 28 天随访时的全因死亡率，独立于 LVSD。
