New-Onset Heart Failure and Mortality in Hospital Survivors of Sepsis-Related Left Ventricular Dysfunction. Issue 2 (February 2018)

• Record Type: Journal Article
• Authors: Vallabhajosyula, Saraschandra; Jentzer, Jacob C.; Geske, Jeffrey B.; Kumar, Mukesh; Sakhuja, Ankit; Singhal, Akhil; Poterucha, Joseph T.; Kashani, Kianoush; Murphy, Joseph G.; Gajic, Ognjen; Kashyap, Rahul
• Is Part Of: Shock. Volume 49:Issue 2(2018)
• Publication Date: 2018-02
• Subjects: Echocardiography -- heart failure -- left ventricular dysfunction -- sepsis -- ADHF -- acute decompensated heart failure -- ICU -- intensive care unit -- IQR -- interquartile range -- LV -- left ventricular -- LVEF -- left ventricular ejection fraction; Shock -- Periodicals; Shock -- Periodicals; Choc (Pathologie) -- Périodiques; Shock; Periodicals; 616.0475
• DOI: 10.1097/SHK.0000000000000952
• Languages: English
• ISSNs: 1073-2322

Abstract

Abstract: Background: The association between new-onset left ventricular (LV) dysfunction during sepsis with long-term heart failure outcomes is lesser understood. Methods: Retrospective cohort study of all adult patients with severe sepsis and septic shock between 2007 and 2014 who underwent echocardiography within 72 h of admission to the intensive care unit. Patients with prior heart failure, LV dysfunction, and structural heart disease were excluded. LV systolic dysfunction was defined as LV ejection fraction <50% and LV diastolic dysfunction as ≥grade II. Primary composite outcome included new hospitalization for acute decompensated heart failure and all-cause mortality at 2-year follow-up. Secondary outcomes included persistent LV dysfunction, and hospital mortality and length of stay. Results: During this 8-year period, 434 patients with 206 (48%) patients having LV dysfunction were included. The two groups had similar baseline characteristics, but those with LV dysfunction had worse function as demonstrated by worse LV ejection fraction, cardiac index, and LV diastolic dysfunction. In the 331 hospital survivors, new-onset acute decompensated heart failure hospitalization did not differ between the two cohorts (15% vs. 11%). The primary composite outcome was comparable at 2-year follow-up between the groups with and without LV dysfunction ( P = 0.24). Persistent LV dysfunction was noted in 28% hospital survivors on follow-up echocardiography. Other secondary outcomes were similar between the two groups. Conclusions: In patients with severe sepsis and septic shock, the presence of new-onset LV dysfunction did not increase the risk of long-term adverse heart failure outcomes. Abstract : Supplemental Digital Content is available in the text