• Michael J Lanspa, Meghan M Cirulis, Brandon M Wiley, Troy D Olsen, Emily L Wilson, Sarah J Beesley, Samuel M Brown, Eliotte L Hirshberg, and Colin K Grissom.
• Critical Care Echocardiography Service, Intermountain Medical Center, St, Murray, UT; Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT. Electronic address: Michael.Lanspa@imail.org.
• Chest. 2021 Mar 1; 159 (3): 1055-1063.

BackgroundSepsis is a frequently lethal state, commonly associated with left ventricular (LV) dysfunction. Right ventricular (RV) dysfunction in sepsis is less well understood.Research QuestionIn septic patients, how common is RV dysfunction, and is it associated with worse outcomes?Study Design And MethodsWe measured echocardiographic parameters on critically ill patients with severe sepsis or septic shock within the first 24 hours of ICU admission. We defined RV dysfunction as fractional area change (FAC) less than 35% or tricuspid annulus systolic plane excursion (TAPSE) less than 1.6 cm. We defined LV systolic dysfunction as ejection fraction (EF) less than 45% or longitudinal strain greater than -19%. Using logistic regression, we assessed the relationship between 28-day mortality and presence of RV dysfunction and LV systolic dysfunction, controlling for receipt of vasopressors, receipt of fluid, mechanical ventilation, and the acute physiology and chronic health evaluation (APACHE II) score.ResultsWe studied 393 patients. RV and LV dysfunction were common (48% and 63%, respectively). Mean echocardiographic values were: RV end-diastolic area, 22.4 ± 7.0 cm2; RV end-systolic area, 14.2 ± 6.0 cm2; RV FAC, 38 ± 11%; TAPSE, 1.8 ± .06 cm; RV longitudinal strain, -15.3 ± 6.5%; LV EF, 60% ± 14%; LV longitudinal strain, -16.5% ± 6.0%. Patients with RV dysfunction had higher 28-day mortality (31% vs 16%, P = .001). In our multivariable regression model, RV dysfunction was associated with increased mortality (OR, 3.4; CI, 1.7-6.8; P = .001), and LV systolic dysfunction was not (OR, 0.63; CI, 0.3 -1.2; P = .32) INTERPRETATION: Right ventricular dysfunction is present in nearly half of studied septic patients and is associated with over threefold higher 28-day mortality.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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