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Original research
Association between right ventricle dysfunction and poor outcome in patients with septic shock
  1. June-sung Kim,
  2. Youn-Jung Kim,
  3. Muyeol Kim,
  4. Seung Mok Ryoo,
  5. Won Young Kim
  1. Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Seoul, Republic of Korea
  1. Correspondence to Dr Won Young Kim, Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea; wonpia73{at}


Objective Sepsis-induced myocardial dysfunction (SIMD) can involve both the left and right ventricles. However, the characteristics and outcomes across various manifestations of SIMD remain unknown.

Methods This was a retrospective cohort study using a prospective registry of septic shock from January 2011 and April 2017. Patients with clinically presumed cardiac dysfunction underwent echocardiography within 72 hours after admission and were enrolled (n=778). SIMD was classified as left ventricle (LV) systolic/diastolic and right ventricle (RV) dysfunction, which were defined based on the American Society of Echocardiography criteria. The primary outcome was 28-day mortality.

Results Of the 778 septic shock patients who underwent echocardiography, 270 (34.7%) showed SIMD. The median age was 67.0 years old, and the male was predominant (57.3%). Among them, 67.3% had LV systolic dysfunction, 40.7% had RV dysfunction and 39.3% had LV diastolic dysfunction. Although serum lactate level and sequential organ failure assessment score were not significantly different between groups, SIMD group showed higher troponin I (0.1 vs 0.1 ng/mL; p=0.02) and poor clinical outcomes, including higher 28-day mortality (35.9 vs 26.8%; p<0.01), longer intensive care unit length of stay (5 vs 2 days; p<0.01) and prolonged mechanical ventilation (9 vs 4 days; p<0.01). Multivariate analysis showed that isolated RV dysfunction was an independent risk factor of 28-day mortality (OR 2.26, 95% CI 1.04 to 4.91).

Conclusions One-third of patients with septic shock showed various myocardial dysfunctions. LV systolic dysfunction was common; however, only RV dysfunction was associated with short-term mortality.

  • myocardial disease
  • echocardiography
  • systemic inflammatory diseases
  • cardiac imaging and diagnostics

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  • Correction notice This article has been corrected since it was published Online First. The affiliation was updated to 'Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea'

  • Contributors JSK participated in drafting, data collecting and analysing. Y-JK and MK participated in conceptualising and data collecting. SMR read and revised the manuscript. WYK supervised, read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the ethics committee of the hospital (no. 2016–0548), and the requirement for informed consent was waived due to the retrospective nature of the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. None.

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