Quantitative Assessment and Prognostic Value of Myocardial Work Indexes in Septic Cardiomyopathy Patients with Left Ventricular Systolic Dysfunction

Abstract Objective : This study was to determine whether myocardial work indexes (MWI) could quantitatively assess left ventricular systolic dysfunction in patients with septic cardiomyopathy (SCM-LVSD) and their predictive efficacy for prognosis in sepsis. Methods : Based on the echocardiographic performance of the left and/or the right ventricular dysfunction, 180 enrolled sepsis were categorized into two groups: the sepsis group and the septic cardiomyopathy (SCM)group . Additionally, the survival group and the mortality group based on their prognosis at 28 days post-admission. Univariate and multivariate logistic regression analyses were performed to explore the relationship between MWI, SCM-LVSD, and prognosis. The diagnostic efficacy of MWI in identifying SCM-LVSD was evaluated using diagnostic tests. Result: ① MWI parameters Comparison: The global work index (GWI), global constructive work (GCW), and global work efficiency (GWE) were significantly reduced in the SCM and mortality groups versus controls (all P <0.01). While, the global wasted work (GWW) was significantly higher in the SCM group than in the sepsis group ( P <0.01). ② Comparison of the diagnostic efficacy in identifying SCM-LVSD: The global longitudinal strain (GLS) demonstrated the highest diagnostic value (area under the receiver operating characteristic curve [AUCs= 0.81], followed by GWI and GCW (AUC=0.77 each)，and GWE (AUC=0.73), the left ventricular ejection fraction (LVEF) and the GWW exhibited lower diagnostic efficacy. ③ Comparison of the prognostic value: GWI, GCW, GLS, and GWE showed the best predictive efficacy for adverse prognosis (AUC of 0.75, 0.74, 0.72, and 0.70, respectively), whereas GWW and LVEF showed limited value. Conclusion : MWI could more accurately quantify the SCM-LVSD. GLS, GWI, and GCW demonstrated higher diagnostic efficacy. Additionally, GWI, GCW, and GWE provided valuable prognostic efficacy for 28-day mortality in sepsis. MWI serves as a valuable tool for the early identification of SCM-LVSD and prognostic assessment of sepsis.