Incidence and Prognostic Impact of Myocardial Dysfunction in Septic Shock: An Observational Cohort Study

Background and aims: Recent sepsis guidelines recognize myocardial dysfunction as a major contributor to the pathophysiology of septic shock. Sepsis-induced cardiomyopathy (SIC) is typically characterized by acute onset and potential reversibility. The present study aimed to determine the incidence, spectrum, and prognostic significance of myocardial dysfunction in patients with septic shock. Patients and methods: We included patients aged 18 years or older diagnosed with septic shock. We excluded those having an improper window for transthoracic echocardiography, known cardiac diseases, pregnancy, or postcardiac arrest status. Eligible patients underwent transthoracic echocardiography within the first 24 hours of intensive care unit (ICU) admission. Echocardiography was used to assess systolic and diastolic function of both ventricles based on the criteria recommended by the American Society of Echocardiography (ASE). For patients with abnormal f indings, a follow-up echocardiogram was conducted on day 7 to assess the reversibility of myocardial dysfunction. Results: Myocardial dysfunction was identified in 39 of 71 patients, yielding an incidence of 54.9% (95% CI: 42.6–66.7). Mortality was significantly higher among patients with SIC, with 29 out of 39 succumbing to the condition. Sepsis-induced cardiomyopathy was characterized by various patterns, including left ventricular (LV) systolic dysfunction, LV diastolic dysfunction, and right ventricular (RV) dysfunction, with LV diastolic dysfunction being the most prevalent. Multivariable regression analysis, adjusting for potential confounders, demonstrated that the presence of SIC was an independent predictor of mortality. Conclusion: Sepsis-induced cardiomyopathy was present in over half of the patients with septic shock, with diastolic dysfunction being the predominant subtype. Sepsis-induced cardiomyopathy was associated with increased mortality.