Usefulness of Findings by Multimodality Imaging to Stratify Risk of Major Adverse Cardiac Events After Sepsis at 1 and 12 months

Am J Cardiol. 2020 Jun 1;125(11):1732-1737. doi: 10.1016/j.amjcard.2020.02.015. Epub 2020 Mar 5.

Abstract

Cardiovascular complications are reported in up to 30% of sepsis survivors. Currently, there is limited evidence to guide cardiovascular risk stratification of septic patients. We propose the use of left ventricular ejection fraction (LVEF) and coronary artery calcification (CAC) on nongated computed tomography (CT) scans to identify septic patients at highest risk for major adverse cardiovascular events (MACE). We retrospectively reviewed 517 adult patients with sepsis, elevated troponin levels, nongated CT scans that visualized the coronaries, and an echocardiogram. Patients were stratified into 4 groups based on the LVEF and presence or absence of CAC. Using the CAC negative/LVEF ≥ 50% as a control, we compared MACE and all-cause mortality outcomes across the patient groups. At 30 days, 39 patients (7.5%) experienced MACE and 166 patients (32%) died. Patients with no CAC and LVEF ≥ 50% experienced no MACE at 30 days or 1 year. Among patients with EF < 50%, CAC positive or negative patients were statistically more likely to experience a MACE event at 30 days (p < 0.001 for both groups). After 30 days, a further 6 patients (1.2%) experienced MACE and 66 (12.7%) patients died within the first year. Patients with CAC positive/LVEF < 50% experienced the highest rates of MACE at 1 year (p < 0.001). In conclusion, the combination of LVEF on echocardiography and CAC on nongated CT scans provides a powerful risk stratification tool for predicting cardiovascular events in septic patients.

MeSH terms

  • Adult
  • Aged
  • Cardiovascular Diseases / mortality*
  • Cohort Studies
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / epidemiology*
  • Coronary Vessels / diagnostic imaging
  • Echocardiography
  • Female
  • Heart / diagnostic imaging
  • Heart / physiopathology
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Mortality
  • Multimodal Imaging
  • Myocardial Infarction / epidemiology*
  • Percutaneous Coronary Intervention / statistics & numerical data*
  • Retrospective Studies
  • Risk Assessment
  • Sepsis / epidemiology*
  • Stroke Volume*
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / epidemiology*
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / epidemiology*
  • Ventricular Dysfunction, Left / physiopathology