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Septic cardiomyopathy phenotype in the critically ill may depend on antimicrobial resistance
Vasiliki Tsolaki1, Kyriaki Parisi1, George E Zakynthinos2
1Intensive Care Unit, University Hospital of Larissa, University of Thessaly Faculty of Medicine, Larissa, Greece.
Background:
Sepsis is a life-threatening organ dysfunction, and septic cardiomyopathy (SCM) may complicate the course of the disease. Infection with multidrug-resistant (MDR) pathogens has been linked with worse outcomes. This study aims to evaluate SCM in patients with infections caused by different antimicrobial-resistant phenotypes.
Method:
This retrospective study included patients with sepsis/septic shock, hospitalized, and intubated in the intensive care unit of the University Hospital of Larissa between January 2022 and September 2023 with echocardiographic data during the first two days after infection onset. The patients were divided into two groups: non-MDR-SCM group and MDR-SCM group. The cardiac function was compared between the two groups.
Result:
A total of 62 patients were included in the study. Forty-four patients comprised the MDR-SCM and 18 the non-MDR-SCM group. Twenty-six patients (41.9%) presented with left ventricular (LV) systolic dysfunction, and ≤35% right ventricular fractional area change (RVFAC) was present in 56.4%. LV systolic function was more severely impaired in the non-MDR-SCM group (left ventricular ejection fraction, 35.8% ±4.9% vs. 45.6%±2.4%, P=0.049; LV outflow tract velocity time integral, [10.1±1.4] cm vs. [15.3±0.74] cm, P=0.001; LV-Strain, -9.02%±0.9% vs. -14.02%±0.7%, P=0.001). The MDR-SCM group presented with more severe right ventricular (RV) dilatation (right ventricular end-diastolic area/left ventricular end-diastolic area, 0.81±0.03 vs. 0.7±0.05, P=0.042) and worse RV systolic function (RVFAC, 32.3%±1.9% vs. 39.6%±2.7%, P=0.035; tricuspid annular plane systolic excursion, [15.9±0.9] mm vs. [18.1±0.9] mm, P=0.165; systolic tissue Doppler velocity measured at the lateral tricuspid annulus, [9.9±0.5] cm/s vs. [13.1±0.8] cm/s, P=0.002; RV-strain, -11.1%±0.7% vs. -15.1%±0.9%, P=0.002).
Conclusion:
SCM related to MDR infection presents with RV systolic dysfunction predominance, while non-MDR-SCM is mainly depicted with LV systolic dysfunction impairment.
Insights
Septic cardiomyopathy (SCM) in multidrug-resistant (MDR) infections primarily affects right ventricular function, unlike non-MDR SCM, which predominantly impacts left ventricular function. This highlights distinct cardiac impacts based on pathogen resistance.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Sepsis is a critical condition leading to organ dysfunction, with septic cardiomyopathy (SCM) being a potential complication.
- Infections caused by multidrug-resistant (MDR) pathogens are associated with poorer patient outcomes.
- Understanding SCM in the context of antimicrobial resistance is crucial for effective patient management.
Purpose of the Study:
- To investigate and compare septic cardiomyopathy (SCM) in patients infected with multidrug-resistant (MDR) pathogens versus non-MDR pathogens.
- To evaluate the differences in cardiac function, specifically left and right ventricular function, between MDR-SCM and non-MDR-SCM groups.
Main Methods:
- A retrospective study involving 62 sepsis/septic shock patients admitted to the intensive care unit between January 2022 and September 2023.
- Patients were categorized into MDR-SCM and non-MDR-SCM groups based on pathogen resistance.
- Echocardiographic data collected within the first two days of infection onset were analyzed to compare cardiac function.
Main Results:
- Left ventricular (LV) systolic dysfunction was observed in 41.9% of patients, and impaired right ventricular fractional area change (RVFAC ≤35%) in 56.4%.
- The non-MDR-SCM group exhibited more severe LV systolic dysfunction (ejection fraction, outflow tract VTI, and strain) compared to the MDR-SCM group.
- The MDR-SCM group showed more significant right ventricular (RV) dilatation and worse RV systolic function (RVFAC, S-wave velocity, and RV strain) than the non-MDR-SCM group.
Conclusions:
- Septic cardiomyopathy associated with multidrug-resistant infections predominantly manifests as right ventricular systolic dysfunction.
- Septic cardiomyopathy in non-MDR infections is primarily characterized by left ventricular systolic dysfunction.
- These findings suggest distinct patterns of cardiac involvement based on the antimicrobial resistance profile of the causative pathogen.
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