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Table 2 Summary of selected articles on septic cardiomyopathy

From: Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: a review of the literature

  Echo parameter Study Study design/setting N Measured outcome Results
Left ventricle       
Systolic EF Sevilla Berrios et al. (2014) [33] Meta-analysis 585 To evaluate the significance of reduced LVEF in patients with severe sepsis and septic shock. Primary outcome was association between depressed LVEF and 30-day mortality Depressed LVEF had a sensitivity of 52% (95% CI 29–73%) and specificity of 63% (95% CI 53–71%) for mortality and was therefore not a sensitive nor specific predictor of mortality
Huang et al. (2013) [32] Meta-analysis 762 To evaluate the association of both reduced LVEF and increased LV dimensions with mortality in patients with severe sepsis and septic shock No significant difference in LVEF and LV dimensions in survivors vs non-survivors
Jardin et al.
(1999) [24]
Single-center prospective cohort study 90 To evaluate changes in LV function, including LVEF and LV volumes, during volume resuscitation in patients with septic shock LVEF was depressed in all patients. LV parameters were additionally unaffected by fluid loading
Parker et al. (1984) [1] Single-center prospective cohort study 20 To evaluate cardiac function in septic shock 10/20 patients (50%) had depressed LVEF (< 0.40). Mean LVEF was lower among survivors (LVEF 0.32 ± 0.04) when compared to non-survivors. Mean ESV and EDV were increased in survivors
GLS Boissier et al.
(2017) [17]
Single-center prospective cohort study/ICU 132 To evaluate the role of GLS, LVEF, and TDI in patients with septic shock. Primary outcome was the role of loading conditions on evaluation of cardiac contractility GLS was impaired in a majority of the patients (> 70%); however, feasibility was limited (< 50%)
Chang et al.
(2015) [39]
Multi-center prospective cohort study/ICU 111 To evaluate LV function, as well as the prognostic value of GLS, in septic patients. Primary outcome was both ICU and hospital mortality GLS is an independent prognostic indicator of ICU mortality. Patients with GLS ≥ − 13% had higher ICU mortality rates (HR 4.34; p < 0.001)
De Geer et al.
(2015) [43]
Single-center prospective cohort study/ICU 50 To evaluate GLS in patients with septic shock. Primary outcomes were mortality at 30 and 90 days GLPS did not correlate between survivors and non-survivors and therefore could not be used to predict mortality
Innocenti et al.
(2016) [41]
Single-center prospective cohort study/ED observation unit 147 To evaluate LVEF and GLS in septic patients. Primary outcome was all-cause mortality at 7 days LVEF is not an independent indicator of prognosis
Kalam et al. (2014) [37] Meta-analysis 5721 To assess if GLS is a more accurate predictor of cardiovascular outcome compared to LVEF. Primary outcome was all-cause mortality. Secondary outcome was composite endpoint including cardiac death, malignant arrhythmia, and hospitalization GLS is a better predictor of adverse outcomes (HR 0.50; p < 0.002) and mortality (HR 1.62; p = 0.009) than LVEF (HR 0.81; p = 0.572)
Ng et al.
(2016) [38]
Case–control study/ICU 62 To evaluate the role of GLS in the diagnosis of SMD. Primary outcome was to compare GLS values in patients with septic shock compared to patients with only sepsis There was a significant difference in GLS values (− 14.5 vs –18.3%, p < 0.001) between patients with septic shock and sepsis. LVEF was not statistically significant between patients with septic shock and patients with sepsis
Orde et al.
(2014) [42]
Single-center prospective cohort study/ICU 60 To evaluate GLS in patients with severe sepsis or septic shock. Primary outcomes were mortality at 30 days and 6 months No difference in mortality for LV GLS or GLS rate in survivors compared with non-survivors at 30 days or 6 months
Palmieri et al.
(2015) [40]
Single-center prospective cohort study/ED observation unit 115 To evaluate LV EF and peak GLS in patients with sepsis and septic shock. Primary outcome was death by any cause at 28 days from hospitalization Abnormal GLS correlates significantly with mortality rate at 28 days. GLS values close to 0 demonstrated a higher mortality (HR 1.16%; p = 0.05).
Zaky et al.
(2016) [44]
Single-center prospective cohort study/ICU 54 To evaluate LVLS in patients with sepsis or septic shock. Primary outcomes were mechanical ventilation, ICU and hospital length of stay, and in-hospital mortality Global LVLS was not associated with rates of mechanical ventilation, ICU or hospital length of stay, or in-hospital mortality
Systolic mitral annular velocity (S′) Chang et al.
(2015) [39]
Multi-center prospective cohort study/ICU 111 To evaluate LV function, as well as the prognostic value of GLS, in septic patients. Primary outcome was both ICU and hospital mortality There was no statistically significant difference in S′ between ICU non-survivors compared to survivors (11.0 ± 4.3 vs 11.4 ± 4.0; p < 0.66)
Weng et al. (2012) [49] Single-center prospective cohort study/ICU 61 To evaluate the prognostic significance of several TDI variables, including systolic mitral annular velocity, S′, in patients with septic shock. Primary outcome was all-cause mortality Non-survivors had a higher S′ when compared to survivors (11.0 vs 7.8 cm/s; p < 0.0001). Patients with S′ > 9 cm/s had a higher mortality rate (75 versus 17%; p < 0.0001). S′ > 9 cm/s had SN 75% and SP 86% to predict 90-day mortality
Weng et al. (2013) [50] Single-center prospective cohort study/ICU 51 To evaluate LV longitudinal systolic dysfunction and LV intraventricular systolic asynchrony assessed by TDI in patients with septic shock and normal LVEF. Primary outcome was all-cause mortality at 28 days Normal EF, LV longitudinal systolic dysfunction and LV systolic asynchrony assessed by TDI within 24 h of onset of septic shock were associated with improved mortality at 28 days
MAPSE Zhang et al. (2017) [65] Case-control study/ICU 45 To evaluate LVEF, MAPSE, Sa, and TAPSE in patients with septic shock. Primary outcome was sepsis MAPSE values were significantly lower in septic patients when compared to non-septic patients (p ≤ 0.001)
MPI Nizamuddin et al. (2017) [78] Single-center prospective cohort study/ICU 47 To assess if changes in LV MPI were associated with higher 90-day mortality in patients with severe sepsis. Primary outcome was all-cause mortality Decline in MPI over the initial 24-h study period was associated with higher mortality at 90 days (p = 0.04)
Diastolic e’ and
E/e’
Brown et al.
(2012) [52]
Single-center prospective cohort study/ICU 78 To evaluate whether severity of diastolic dysfunction predicts mortality in patients with severe sepsis or septic shock. Primary outcome was mortality at 28 days Grade I diastolic dysfunction was associated with increased mortality; grades II/III were not associated with increased mortality
Landesberg et al. (2012) [54] Single-center prospective cohort study/ICU 262 To evaluate the association between diastolic dysfunction and mortality in severe sepsis and septic shock. Primary outcomes were in-hospital mortality and overall mortality at 6 months to 2 years Decreased septal e’ or increased septal E/e’ were the strongest independent predictors of mortality (HR 0.76, p ≤ 0.001 and HR 1.08, p ≤ 0.001, respectively)
Rolando et al.
(2015) [57]
Single-center prospective cohort study/ICU 53 To evaluate the prognostic significance of myocardial dysfunction, including E/e’ ratio, in patients with severe sepsis and septic shock. Primary outcome was hospital mortality E/e’ is an independent predictor of hospitality mortality (OR = 1.36; p = 0.02). An E/e’ > 11 had a sensitivity of 50% and specificity of 94% for predicting ICU mortality
Sanfilippo et al. (2017) [59] Meta-analysis 1507 To evaluate the association of e’ and E/e’ with mortality in patients with severe sepsis or septic shock A significant association was found between mortality and both a lower e’ (SC 0.33; 95% CI 0.05, 0.62; p = 0.02) and higher E/e’ (SC 0.33; 95% CI – 0.57, − 0.10; p = 0.006) in patients with severe sepsis and/or septic shock. There was high overall heterogeneity in both e’ and E/e’ analysis
Sturgess et al.
(2010) [56]
Single-center prospective cohort study/ICU 21 To evaluate the prognostic significance of TDI and cardiac biomarkers in septic shock. Primary outcome was hospital mortality E/e’ is an independent predictor of hospital survival and is a better prognosticator than cardiac biomarkers. E/e’ was greater in non-survivors than survivors (15.32 ± 2.74 vs 9.05 ± 2.75, respectively; p = 0.0002)
Lanspa et al. (2016) [60] Single-center prospective cohort study/ICU 167 To compare the feasibility and prognostic significance of a simplified definition of diastolic dysfunction (using e’ and E/e’) with 2009 ASE guidelines. Primary outcome was 28-day mortality Simplified definition had better feasibility (87 vs 35%); similar clinical outcomes between groups suggesting limited utility of LAVI and DT in this setting
Right ventricle       
Systolic TAPSE Gajanana et al.
(2015) [64]
Single-center prospective cohort study/ICU 120 To evaluate the prognostic value of TAPSE in patients with critical illness A reduced TAPSE measurement (< 2.4 cm) was correlated with increased in-hospital mortality (χ(2) = 4.6, P = 0.03) and a longer length of hospital stay
TAPSE
TDI
RV FAC
Vallabhajosyula et al. (2017) [67] Single-center retrospective cohort study/ICU 388 To evaluate the prognostic significance RV dysfunction in patients with severe sepsis and septic shock. Primary outcome was 1-year survival Isolated RV dysfunction is an independent predictor of 1-year survival (HR 1.6; p = 0.002). Combined RV/LV dysfunction was not an independent predictor of 1-year survival (HR 0.9; p = 0.52)
  1. ASE American Society of Echocardiography, CI confidence interval, DT mitral inflow deceleration time, EDV end diastolic volume, ESV end systolic volume, FAC fractional area change, GLPS global longitudinal peak strain, GLS global longitudinal strain, HR hazard ratio, ICU intensive care unit, LAVI left atrial volume index, LV left ventricle, LVEF left ventricular ejection fraction, LVLS left ventricular longitudinal strain, MAPSE mitral annular plane systolic excursion, OR odds ratio, RV right ventricle, Sa tissue Doppler velocity measurement of mitral annulus, SC septic cardiomyopathy, SMD standard mean difference, SN sensitivity, SP specificity, STE speckle tracking echocardiography, TDI tissue Doppler imaging