Division of Pulmonary, Department of Medicine, Intermountain Medical Center, Salt Lake City, UT.
Division of Pulmonary, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT.
Crit Care Med. 2021 Apr 1;49(4):e444-e453. doi: 10.1097/CCM.0000000000004886.
Septic cardiomyopathy develops frequently in patients with sepsis and likely increases short-term mortality. However, whether septic cardiomyopathy is associated with long-term outcomes after sepsis is unknown. We investigated whether septic patients with septic cardiomyopathy have worse long-term outcomes than septic patients without septic cardiomyopathy.
Retrospective cohort study.
Adult ICU.
Adult ICU patients with sepsis.
None.
Left ventricular global longitudinal systolic strain was our primary measure of septic cardiomyopathy. We employed a suite of multivariable survival analyses to explore linear and nonlinear associations between left ventricular global longitudinal systolic strain and major adverse cardiovascular events, which included death, stroke, and myocardial infarction. Our primary outcome was major adverse cardiovascular event through 24 months after ICU discharge. Among 290 study patients, median left ventricular global longitudinal systolic strain was -16.8% (interquartile range, -20.4% to -12.6%), and 38.3% of patients (n = 111) experienced a major adverse cardiovascular event within 24 months after discharge. On our primary, linear analysis, there was a trend (p = 0.08) toward association between left ventricular global longitudinal systolic strain and major adverse cardiovascular event (odds ratio, 1.03; CI, < 1 to 1.07). On our nonlinear analysis, the association was highly significant (p < 0.001) with both high and low left ventricular global longitudinal systolic strain associated with major adverse cardiovascular event among patients with pre-existing cardiac disease. This association was pronounced among patients who were younger (age < 65 yr) and had Charlson Comorbidity Index greater than 5.
Among patients with sepsis and pre-existing cardiac disease who survived to ICU discharge, left ventricular global longitudinal systolic strain demonstrated a U-shaped association with cardiovascular outcomes through 24 months. The relationship was especially strong among younger patients with more comorbidities. These observations are likely of use to design of future trials.
脓毒症心肌病在脓毒症患者中经常发生，可能会增加短期死亡率。然而，脓毒症心肌病是否与脓毒症后的长期预后相关尚不清楚。我们研究了患有脓毒性心肌病的脓毒症患者是否比没有脓毒性心肌病的脓毒症患者预后更差。
回顾性队列研究。
成人 ICU。
患有脓毒症的成人 ICU 患者。
无。
左心室整体纵向收缩应变是我们脓毒性心肌病的主要测量指标。我们采用了一系列多变量生存分析方法来探讨左心室整体纵向收缩应变与主要不良心血管事件（包括死亡、卒中和心肌梗死）之间的线性和非线性关系。我们的主要结局是 ICU 出院后 24 个月内的主要不良心血管事件。在 290 名研究患者中，中位数左心室整体纵向收缩应变值为-16.8%（四分位间距，-20.4%至-12.6%），出院后 24 个月内 38.3%的患者（n=111）发生了主要不良心血管事件。在我们的主要线性分析中，左心室整体纵向收缩应变与主要不良心血管事件之间存在趋势（p=0.08）（比值比，1.03；CI，<1 至 1.07）。在我们的非线性分析中，这种关联具有高度显著性（p<0.001），对于存在预先存在的心脏病的患者，左心室整体纵向收缩应变较高和较低都与主要不良心血管事件相关。这种关联在年龄较小（<65 岁）和 Charlson 合并症指数大于 5 的患者中更为明显。
在存活至 ICU 出院的患有脓毒症和预先存在的心脏病的患者中，左心室整体纵向收缩应变与 24 个月内的心血管结局呈 U 形相关。在合并症更多的年轻患者中，这种关系尤其强烈。这些观察结果可能对未来试验的设计有用。
