Research Article

Prognostic Implications of Elevated Left Ventricular Ejection Fraction in Patients with Sepsis

DOI:

10.3791/69647

January 16th, 2026

In This Article

Summary

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This study evaluates sepsis patients at Beth Israel Deaconess Medical Center to determine whether elevated left ventricular ejection fraction predicts 28-day mortality.

Abstract

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The role of left ventricular systolic function as a prognostic marker for sepsis patients remains an area of ongoing research and debate. The present investigation exhibited the comprehensive evaluation of the relationship between different levels of left ventricular ejection fraction (LVEF) and mortality outcomes in sepsis-diagnosed patients. A retrospective, single-center longitudinal cohort investigation was conducted involving the intensive care unit (ICU) admitted adults' patients at Beth Israel Deaconess Medical Center who underwent transthoracic echocardiography (TTE) during their hospitalization. Individuals diagnosed with sepsis and who received Doppler echocardiography were included in the analysis if transthoracic echocardiography was performed within seven days of ICU admission. All patients of age below 18 or above 90 years, a prior history of cardiac disease or cardiac surgery, and those for whom echocardiography was performed more than seven days after ICU admission were excluded. Patients were stratified into three distinct groups with relation to their LVEF levels: hyperdynamic (LVEF ≥70%), normal (LVEF 55%-70%), and depressed (LVEF ≤55%). The association between different categories of sepsis affected patients mortality outcome and left ventricular ejection fraction (LVEF) was assessed. Among the 3,363 patients analyzed, comprising 1,175 with decreased LVEF, 2,119 with normal LVEF, and 68 with hyperdynamic LVEF, multivariate Cox regression identified hyperdynamic function as the strongest predictor of 28-day mortality. Specifically, hyperdynamic LVEF was independently linked to a 3.643-fold higher hazard of death relative to the normal LVEF group. A significant link has been identified between hyperdynamic left ventricular function and elevated 28-day mortality rates in the ICU-admitted septic patients. This physiological condition underscores the need for enhanced clinical awareness due to its prognostic significance.

Introduction

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Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection1. Among the organs affected, the heart is particularly susceptible. The reversible myocardial dysfunction that arises during sepsis, in the absence of underlying ischemic heart disease or pre-existing cardiac conditions, is referred to clinically as septic cardiomyopathy (SCM). The reported incidence of septic cardiomyopathy varies widely, ranging from 10% to 70%2,3.

An important clinical inquiry persists: to what extent does septic cardiomyopathy imp....

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Protocol

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The study was conducted using de-identified patient data from the MIMIC-IV database (version 2.2). Approval for use of this dataset was granted by the Institutional Review Board of the Beth Israel Deaconess Medical Center, with a waiver of informed consent due to the anonymized nature of the data. Access to the database was authorized under certification number 60177335. The equipment used is listed in the Table of Materials.

1. Data source

The MIMIC-IV (version 2.2) database was accessed through the PhysioNet platform after completion of the required training. Clinical, laboratory....

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Results

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Baseline characteristics
As shown in Figure 1, the final analysis included 3,362 patients. Of these, 1,175 were categorized into the reduced LVEF group (≤55%), 2,119 had normal LVEF (55%-70%), and 68 patients demonstrated hyperdynamic LVEF (>70%). Table 1 presents the baseline demographic and clinical characteristics of the study population. The cohort had a median age of 69 years (IQR 60-77), and males represented 66% (n = 2,218) of the samp.......

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Discussion

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This study demonstrates a significant association between hyperdynamic left ventricular ejection fraction (LVEF) and increased 28-day mortality among septic patients admitted to the intensive care unit. This association remained consistent even after adjusting for confounding variables, underscoring the robustness of the findings. These results align with previously published work that has reported similar physiological patterns among patients with hyperdynamic ventricular function, including elevated cardiac output, inc.......

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Disclosures

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The authors declare no competing interests.

Materials

List of materials used in this article
NameCompanyCatalog NumberComments
Color Doppler Echocardiography unitSiemens Siemens Acuson X300 / X700 SeriesUsed to evaluate blood flow, cardiac hemodynamics, and support LVEF measurement
Transthoracic Echocardiography (TTE) SystemSiemens Siemens Acuson SC2000 PRIMEUsed for cardiac ultrasound imaging; LVEF

References

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  1. Singer, M., Deutschman, C. S., Seymour, C. W. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 315 (8), 801-810 (2016).
  2. Hollenberg, S. M., Singer, M. Pathophysiology of sepsis-induced cardiomyopathy. Nat Rev Cardiol. 18

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Tags

Left Ventricular EjectionSepsis PrognosisHyperdynamic LVEFTransthoracic EchocardiographyICU MortalitySystolic FunctionDoppler EchocardiographyCox RegressionCardiac FunctionMortality Outcome

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