Prevalence and prognostic value of various types of right ventricular dysfunction in mechanically ventilated septic patients

Hongmin Zhang, Wei Huang, Qing Zhang, Xiukai Chen, Xiaoting Wang, Dawei Liu, Critical Care Ultrasound Study Group, Hongmin Zhang, Wei Huang, Qing Zhang, Xiukai Chen, Xiaoting Wang, Dawei Liu, Critical Care Ultrasound Study Group

Abstract

Introduction: Right ventricle (RV) dilation in combination with elevated central venous pressure (CVP), which is a state of RV congestion, is seen as a sign of RV failure (RVF). On the other hand, RV systolic function is usually assessed by tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC). This study aimed to investigate the prevalence and prognostic value of RVF and RV systolic dysfunction (RVSD) in septic patients.

Methods: Mechanically ventilated sepsis and septic shock patients were included. We collected haemodynamic and echocardiographic parameters as well as prognostic information including mechanical ventilation duration, length of ICU stay and 30-day mortality. RVF was defined as a right and left ventricular end-diastolic area ratio ≥ 0.6 in combination with CVP ≥ 8 mmHg. RVSD was defined as TAPSE < 16 mm or FAC < 35%.

Results: A total of 215 patients were enrolled in this study, and the patients were divided into 4 groups: patients with normal RV function (normal, n = 101), patients with RVF but without RVSD (RVF only, n = 38), patients with RVSD but without RVF (RVSD only, n = 44), and patients with combined RVF-RVSD (RVF/RVSD, n = 32). The RVF/RVSD group and RVSD only group had a lower cardiac index than the RVF only group and normal groups (p < 0.05). At 30 days after ICU admission, 50.0% of patients had died in the RVF/RVSD group, which was much higher than the mortality in the RVF only group (13.2%) and normal group (13.9%) (p < 0.05). In a Cox regression analysis, the presence of RVF/RVSD was independently associated with 30-day mortality (HR 3.004, 95% CI:1.370-6.587, p = 0.006). In contrast, neither the presence of RVF only nor the presence of RVSD only was associated with 30-day mortality (HR 0.951, 95% CI:0.305-2.960, p = 0.931; HR 1.912, 95% CI:0.853-4.287, p = 0.116, respectively).

Conclusion: The presence of combined RVF-RVSD was associated with 30-day mortality in mechanically ventilated septic patients. Additional studies are needed to confirm and expand this finding.

Keywords: Prognosis; Right ventricular failure; Right ventricular systolic dysfunction; Sepsis.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of the study. MV mechanical ventilation, CVP central venous pressure, RV right ventricle, RVF only patients with RV failure but without RV systolic dysfunction, RVSD only patients with RVSD but without RV failure; RVF/RVSD patients with combined RVF–RVSD
Fig. 2
Fig. 2
Haemodynamic and echocardiographic parameters in four groups. a RVF/RVSD group had higher CVP than RVSD only group and normal group (p < 0.005). RVF only group had higher CVP than normal group (p < 0.005). b RVF/RVSD group and RVF only group had higher R/LVEDA ratio than RVSD only group and normal group (p < 0.05). c RVF/RVSD group and RVSD only group had lower TAPSE than RVF only group and normal group (p < 0.05). d RVF/RVSD group and RVSD only group had lower FAC than RVF only group and normal group (p < 0.05). e RVF/RVSD group and RVSD only group had lower LVEF than normal group (p < 0.05). f RVF/RVSD group and RVSD only group had lower CI than RVF only group and normal group (p < 0.05)
Fig. 3
Fig. 3
ROC curve analysis of CVP, R/LVEDA, TAPSE, and FAC for 30 day mortality. CVP central venous pressure, R/LVEDA ratio of right and left ventricular end-diastolic area, TAPSE tricuspid annular plane systolic excursion, FAC fractional area change. The ROC analysis showed that the area under the curve for CVP, R/LVEDA, TAPSE and FAC were 0.644, p = 0.006; 0.525, p = 0.634; 0.652, p = 0.004 and 0.690, p < 0.001, respectively
Fig. 4
Fig. 4
The Kaplan–Meier curves for estimated survival analysis. The RVF/RVSD group had the highest mortality (RVF/RVSD vs. RVSD only, log-rank:3.662, p = 0.057; RVF/RVSD vs. RVF only, log-rank:12.613, p < 0.001; RVF/RVSD vs. normal, log-rank:25.208, p < 0.001); The RVSD only group had higher mortality than the RVF only and normal groups (RVSD only vs. RVF only, log-rank:3.995, p = 0.046; RVSD only vs. normal, log-rank: 7.376, p = 0.007); No difference was found between the RVF only group and the normal group (RVF only vs. Normal, log-rank: 0.012, p = 0.912). RVF only patients with RV failure but without RV systolic dysfunction, RVSD only patients with RVSD but without RV failure, RVF/RVSD patients with combined RVF–RVSD

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