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Regional left ventricular systolic dysfunction associated with critical illness: incidence and effect on outcome
AIMS: Left ventricular (LV) dysfunction can be triggered by non‐cardiac disease, such as sepsis, hypoxia, major haemorrhage, or severe stress (Takotsubo syndrome), but its clinical importance is not established. In this study, we evaluate the incidence and impact on mortality of LV dysfunction assoc...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8712834/ https://www.ncbi.nlm.nih.gov/pubmed/34605611 http://dx.doi.org/10.1002/ehf2.13633 |
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author | Cavefors, Oscar Holmqvist, Jacob Bech‐Hanssen, Odd Einarsson, Freyr Norberg, Erik Lundin, Stefan Omerovic, Elmir Ricksten, Sven‐Erik Redfors, Björn Oras, Jonatan |
author_facet | Cavefors, Oscar Holmqvist, Jacob Bech‐Hanssen, Odd Einarsson, Freyr Norberg, Erik Lundin, Stefan Omerovic, Elmir Ricksten, Sven‐Erik Redfors, Björn Oras, Jonatan |
author_sort | Cavefors, Oscar |
collection | PubMed |
description | AIMS: Left ventricular (LV) dysfunction can be triggered by non‐cardiac disease, such as sepsis, hypoxia, major haemorrhage, or severe stress (Takotsubo syndrome), but its clinical importance is not established. In this study, we evaluate the incidence and impact on mortality of LV dysfunction associated with critical illness. METHODS AND RESULTS: In this single‐centre, observational study, consecutive patients underwent an echocardiographic examination within 24 h of intensive care unit (ICU) admission. LV systolic dysfunction was defined as an ejection fraction (EF) < 50% and/or regional wall motion abnormalities (RWMA). A cardiologist assessed patients with LV dysfunction for the presence of an acute or chronic cardiac disease, and coronary angiography was performed in high‐risk patients. Of the 411 patients included, 100 patients (24%) had LV dysfunction and in 52 (13%) of these patients, LV dysfunction was not attributed to a cardiac disease. Patients with LV dysfunction and non‐cardiac disease had higher mortality risk score (Simplified Acute Physiologic Score 3 score), heart rate, noradrenaline doses, and lactate levels as well as decreased EF, stroke volume, and cardiac output compared with patients with normal LV function. Diagnoses most commonly associated with LV dysfunction and non‐cardiac disease were sepsis, respiratory insufficiency, major haemorrhage, and neurological disorders. RWMA (n = 40) with or without low EF was more common than global hypokinesia (n = 12) and was reversible in the majority of cases. Twelve patients had a circumferential pattern of RWMA in concordance with Takotsubo syndrome. Crude 30 day mortality was higher in patients with LV dysfunction and non‐cardiac disease compared with patients with normal LV function (33% vs. 18%, P = 0.023), but not after risk adjustment (primary outcome) {odds ratio [OR] 1.56 [confidence interval (CI) 0.75–3.39], P = 0.225}. At 90 days, crude mortality was 44% and 22% (P = 0.002), respectively, in these groups. This difference was also significant after risk adjustment [OR 2.40 (CI 1.18–4.88), P = 0.016]. CONCLUSIONS: Left ventricular systolic dysfunction is commonly triggered by critical illness, is frequently seen as regional hypokinesia, and is linked to an increased risk of death. The prognostic importance of LV dysfunction in critical illness might be underestimated. |
format | Online Article Text |
id | pubmed-8712834 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-87128342022-01-04 Regional left ventricular systolic dysfunction associated with critical illness: incidence and effect on outcome Cavefors, Oscar Holmqvist, Jacob Bech‐Hanssen, Odd Einarsson, Freyr Norberg, Erik Lundin, Stefan Omerovic, Elmir Ricksten, Sven‐Erik Redfors, Björn Oras, Jonatan ESC Heart Fail Original Articles AIMS: Left ventricular (LV) dysfunction can be triggered by non‐cardiac disease, such as sepsis, hypoxia, major haemorrhage, or severe stress (Takotsubo syndrome), but its clinical importance is not established. In this study, we evaluate the incidence and impact on mortality of LV dysfunction associated with critical illness. METHODS AND RESULTS: In this single‐centre, observational study, consecutive patients underwent an echocardiographic examination within 24 h of intensive care unit (ICU) admission. LV systolic dysfunction was defined as an ejection fraction (EF) < 50% and/or regional wall motion abnormalities (RWMA). A cardiologist assessed patients with LV dysfunction for the presence of an acute or chronic cardiac disease, and coronary angiography was performed in high‐risk patients. Of the 411 patients included, 100 patients (24%) had LV dysfunction and in 52 (13%) of these patients, LV dysfunction was not attributed to a cardiac disease. Patients with LV dysfunction and non‐cardiac disease had higher mortality risk score (Simplified Acute Physiologic Score 3 score), heart rate, noradrenaline doses, and lactate levels as well as decreased EF, stroke volume, and cardiac output compared with patients with normal LV function. Diagnoses most commonly associated with LV dysfunction and non‐cardiac disease were sepsis, respiratory insufficiency, major haemorrhage, and neurological disorders. RWMA (n = 40) with or without low EF was more common than global hypokinesia (n = 12) and was reversible in the majority of cases. Twelve patients had a circumferential pattern of RWMA in concordance with Takotsubo syndrome. Crude 30 day mortality was higher in patients with LV dysfunction and non‐cardiac disease compared with patients with normal LV function (33% vs. 18%, P = 0.023), but not after risk adjustment (primary outcome) {odds ratio [OR] 1.56 [confidence interval (CI) 0.75–3.39], P = 0.225}. At 90 days, crude mortality was 44% and 22% (P = 0.002), respectively, in these groups. This difference was also significant after risk adjustment [OR 2.40 (CI 1.18–4.88), P = 0.016]. CONCLUSIONS: Left ventricular systolic dysfunction is commonly triggered by critical illness, is frequently seen as regional hypokinesia, and is linked to an increased risk of death. The prognostic importance of LV dysfunction in critical illness might be underestimated. John Wiley and Sons Inc. 2021-10-04 /pmc/articles/PMC8712834/ /pubmed/34605611 http://dx.doi.org/10.1002/ehf2.13633 Text en © 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Articles Cavefors, Oscar Holmqvist, Jacob Bech‐Hanssen, Odd Einarsson, Freyr Norberg, Erik Lundin, Stefan Omerovic, Elmir Ricksten, Sven‐Erik Redfors, Björn Oras, Jonatan Regional left ventricular systolic dysfunction associated with critical illness: incidence and effect on outcome |
title | Regional left ventricular systolic dysfunction associated with critical illness: incidence and effect on outcome |
title_full | Regional left ventricular systolic dysfunction associated with critical illness: incidence and effect on outcome |
title_fullStr | Regional left ventricular systolic dysfunction associated with critical illness: incidence and effect on outcome |
title_full_unstemmed | Regional left ventricular systolic dysfunction associated with critical illness: incidence and effect on outcome |
title_short | Regional left ventricular systolic dysfunction associated with critical illness: incidence and effect on outcome |
title_sort | regional left ventricular systolic dysfunction associated with critical illness: incidence and effect on outcome |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8712834/ https://www.ncbi.nlm.nih.gov/pubmed/34605611 http://dx.doi.org/10.1002/ehf2.13633 |
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