OBJECTIVES: 

To evaluate the cause and prognosis of hyperdynamic left ventricular ejection fraction in critically ill patients with sepsis.

DESIGN: 

Retrospective, single-center cohort study.

SETTING: 

University Hospital ICU, Birmingham, United Kingdom.

PATIENTS: 

ICU patients who received a transthoracic echocardiogram within 7 days of sepsis between April 2016 and December 2019.

INTERVENTION: 

None.

MEASUREMENTS AND MAIN RESULTS: 

The 90-day mortality rates of normal (55–70%), depressed (< 55%), and hyperdynamic left ventricular ejection fraction (> 70%) were compared. Multivariate logistic regression analysis was performed to determine the association of left ventricular ejection fraction phenotypes with mortality and the association of clinical variables with left ventricular ejection fraction phenotypes. One thousand fourteen patients met inclusion criteria and were 62 years old (interquartile range, 47–72), with mostly respiratory infections (n = 557; 54.9%). Ninety-day mortality was 32.1% (n = 325). Patients with hyperdynamic left ventricular ejection fraction had a higher mortality than depressed and normal left ventricular ejection fraction cohorts (58.9% [n = 103] vs 34.0% [n = 55] vs 24.7% [n = 167]; p < 0.0001, respectively). After multivariate logistic regression, hyperdynamic left ventricular ejection fraction was independently associated with mortality (odds ratio, 3.90 [2.09–7.40]), whereas depressed left ventricular ejection fraction did not (odds ratio, 0.62 [0.28–1.37]). Systemic vascular resistance was inversely associated with hyperdynamic left ventricular ejection fraction (odds ratio, 0.79 [0.58–0.95]), and age, frailty, and ischemic heart disease were associated with depressed left ventricular ejection fraction.

CONCLUSIONS: 

Hyperdynamic left ventricular ejection fraction was associated with mortality in septic ICU patients and may reflect unmitigated vasoplegia from sepsis. Depressed left ventricular ejection fraction was not associated with mortality but was associated with cardiovascular disease.

中文翻译：

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ICU 脓毒症患者的高动力左心室射血分数

目标： 

评估脓毒症危重患者左心室射血分数高动力的原因和预后。

设计： 

回顾性、单中心队列研究。

环境： 

英国伯明翰大学医院 ICU。

患者： 

2016年4月至2019年12月间脓毒症发生后7天内接受经胸超声心动图的ICU患者。

干涉： 

没有任何。

测量和主要结果： 

比较左心室射血分数正常（55-70%）、抑郁（< 55%）和高动力左心室射血分数（> 70%）的 90 天死亡率。进行多变量逻辑回归分析以确定左心室射血分数表型与死亡率的关联以及临床变量与左心室射血分数表型的关联。1,14 名患者符合纳入标准，年龄为 62 岁（四分位数范围，47-72 岁），主要患有呼吸道感染（n = 557；54.9%）。90 天死亡率为 32.1% ( n = 325)。左心室射血分数高动力患者的死亡率高于左心室射血分数低下组和正常左心室射血分数组（分别为 58.9% [ n = 103] vs 34.0% [ n = 55] vs 24.7% [ n = 167]；p < 0.0001 ）。多变量 Logistic 回归后，高动力左心室射血分数与死亡率独立相关（比值比，3.90 [2.09–7.40]），而左心室射血分数降低则不然（比值比，0.62 [0.28–1.37]）。全身血管阻力与高动力左心室射血分数呈负相关（比值比，0.79 [0.58-0.95]），年龄、虚弱和缺血性心脏病与左心室射血分数降低相关。

结论： 

高动力左心室射血分数与脓毒症 ICU 患者的死亡率相关，可能反映脓毒症引起的血管麻痹未缓解。左心室射血分数降低与死亡率无关，但与心血管疾病相关。