(1440) Assessing the Impact of Septic Cardiomyopathy on the Right Ventricle: A Serial Echocardiogram Study

Introduction: Septic shock can lead to multi-organ dysfunction, including septic cardiomyopathy affecting the heart. While left ventricle (LV) alterations are well-documented, there is limited knowledge concerning the impact of sepsis on the right ventricle (RV). Our study aims to identify RV changes in sepsis patients using serial echocardiography (echo) images.

Methods: In this retrospective study (IRB 20-008691),197 sepsis patients were admitted to the Mayo Clinic hospitals (August 2018 to September 2022). We collected pre-septic and two post-septic echos from a sepsis database and electronic medical records. We identified abnormalities in ventricular function and size from published echocardiography reports. Categorical and continuous variables were compared by chi-square and independent sample median tests, respectively. Statistical analysis was performed using BlueSky v10.3.1.

Results: Our study included 197 sepsis patients, median age 69 years, predominantly male (67.65%), white (90.5%), and non-Hispanic or Latino (91.4%). Serial echos revealed a gradual decrease in LV ejection fraction (60% vs. 57% vs. 55%, p=0.04), stroke volume (77 ml vs. 75 ml vs. 66.50 ml, p=0.002), cardiac index (3.08 L/min/m2 vs. 3.28 L/min/m2 vs. 2.94 L/min/m2, p=0.04), tricuspid annular plane systolic excursion (TAPSE) (18.50 vs. 16.00 vs. 14.00, p=0.04), and normal RV function (66.8% vs. 51.6% vs. 53.1%, p=0.03).

155 patients survived, while 42 did not. In the first post-sepsis echo, non-survivors were more likely to experience a noticeable decrease in normal RV function (44.7% vs. 53.3%, p=0.003), with no significant differences observed in LV size, LV function, and RV size. However, in the second echo, non-survivors had a more significant decrease in LV function (51.9% vs. 79.3%, p=0.03), average RV size (31.7% vs. 57.8%, p=0.002), and RV function (33.3% vs. 58.7%, p< 0.001). Except for a lower BMI in non-survivors, no difference in baseline demographics and comorbidities was noted between the two groups.

Conclusions: Our study observed consistent RV changes and a decrease in the TAPSE throughout the disease course. Non-survivors exhibited more noticeable alterations in RV size and function during the second post-sepsis echo, emphasizing the importance of continuous monitoring to identify higher-risk patients.