Prognostic implication of a novel right ventricular injury score in septic patients

Hongmin Zhang; Dingding Zhang; Xiaoting Wang; Ye Liu; Hui Lian; Qing Zhang; Hua Zhao; Xiukai Chen; Dawei Liu

doi:10.1002/ehf2.14289

Prognostic implication of a novel right ventricular injury score in septic patients

ESC Heart Fail. 2023 Apr;10(2):1205-1213. doi: 10.1002/ehf2.14289. Epub 2023 Jan 22.

Authors

Hongmin Zhang¹, Dingding Zhang², Xiaoting Wang¹, Ye Liu³, Hui Lian⁴, Qing Zhang¹, Hua Zhao¹, Xiukai Chen⁵, Dawei Liu¹

Affiliations

¹ Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.
⁴ Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁵ School of Medicine, Pittsburgh Heart, Lung, Blood and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Abstract

Aims: We aim to investigate the prognostic value of a right ventricular (RV) injury score based on the concept of RV dilation, RV systolic dysfunction, and RV-pulmonary arterial (PA) decoupling in septic patients and to explore whether the RV injury (RVI) score can be used to grade the severity of RV dysfunction in these patients.

Methods and results: Septic patients admitted to the ICU were prospectively included. We collected haemodynamic and echocardiographic parameters as well as prognostic information. RV dilation was defined as right and left ventricular end-diastolic area ratio (R/LVEDA) > 2/3. RVSD was defined as tricuspid annular plane systolic excursion (TAPSE) < 17 mm, right ventricular fractional area change (FAC) < 35%, or peak velocity of tricuspid annulus via tissue Doppler (S') < 10 cm/s. RV-PA decoupling was represented by the TAPSE/pulmonary arterial systolic pressure (PASP) ratio. RVI score were determined by the presence of the following findings: RVSD, RV dilation, and RV-PA decoupling, that is, one point for each finding. A total of 327 patients were enrolled in this study, among whom 276 survived and 51 died at 30 days after admission. Overall, 18.0% had RV dilation, 35.8% had RVSD, and 21.4% had RV-PA decoupling, with an appreciable overlap present. A multivariate Cox regression analysis showed that RV dilation (HR: 2.19, 95% CI: 1.19-4.01, P = 0.011), RVSD (HR: 2.25, 95% CI: 1.23-4.13, P = 0.009) and RV-PA decoupling (HR: 2.08, 95% CI: 1.19-3.65, P = 0.011) were independently associated with a 30 day mortality. Furthermore, RVI score was also an independent predictor, displayed additive effect with respect to 30 day mortality (RVI score 1 vs. RVI score 0, HR: 2.94, 95% CI: 1.20-7.20, P = 0.018; RVI score 2 vs. RVI score 0, HR: 3.20, 95% CI: 1.28-7.98, P = 0.013; RVI score 3 vs. RVI score 0, HR: 7.17, 95% CI: 2.65-19.38, P < 0.001), and had the best performance in model goodness of fit, discrimination and variance explained than the other RV indices.

Conclusions: The RVI score was independently related to 30 day mortality and had the potential to grade the severity of RV dysfunction in septic patients.

Keywords: Echocardiography; Prognosis; Right ventricular dysfunction; Sepsis.

MeSH terms

Echocardiography
Hemodynamics
Humans
Hypertension, Pulmonary*
Prognosis
Sepsis* / complications
Sepsis* / diagnosis