Septic cardiomyopathy phenotype in the critically ill may depend on antimicrobial resistance

Vasiliki Tsolaki; Kyriaki Parisi; George E Zakynthinos; Efrosini Gerovasileiou; Nikitas Karavidas; Vassileios Vazgiourakis; Epaminondas Zakynthinos; Demosthenes Makris

doi:10.1016/j.jointm.2023.11.009

Septic cardiomyopathy phenotype in the critically ill may depend on antimicrobial resistance

J Intensive Med. 2024 Apr 8;4(3):355-361. doi: 10.1016/j.jointm.2023.11.009. eCollection 2024 Jul.

Authors

Vasiliki Tsolaki¹, Kyriaki Parisi¹, George E Zakynthinos², Efrosini Gerovasileiou³, Nikitas Karavidas¹, Vassileios Vazgiourakis¹, Epaminondas Zakynthinos¹, Demosthenes Makris¹

Affiliations

¹ Intensive Care Unit, University Hospital of Larissa, University of Thessaly Faculty of Medicine, Larissa, Greece.
² Third Cardiology Clinic, University of Athens, Sotiria Hospital, Athens, Greece.
³ Respiratory Department, University Hospital of Larissa, University of Thessaly Faculty of Medicine, Larissa, Greece.

Abstract

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.

Keywords: Left ventricular failure; Left/right ventricular longitudinal strain; Multidrug-resistant pathogen; Right ventricular dysfunction; Septic cardiomyopathy; Ventriculoarterial coupling.