myoCardial work & Right ventricle Strain In Sepsis (CRiSIS): new investigations in critical care echocardiography

Background The understanding of sepsis-related changes in myocardial function is evolving. This study aimed to determine whether myocardial work (MW) and right ventricular free wall strain (RV FWS) were associated with 30-day mortality in critically ill patients presenting with sepsis. Methods We conducted a single-centre prospective observational cohort pilot study to investigate MW and RV FWS in patients with sepsis. Measurements were recorded for 32 patients on days 1 and 3 of admission: 22 (69%) survivors and 10 (31%) non-survivors at 30 days. We used permutation tests, nonparametric bootstrapping and Bayesian analysis to interpret these effects. Results A significant difference in global work efficiency (GWE) was identified on day 3, with survivors showing higher GWE (94%, IQR 91-95%) compared to non-survivors (88.5%, IQR 85-92%; p = 0.02, BF ₁₀ = 1.44). No significant differences in interval changes in MW or RV FWS were found. Bayesian analysis supported a possible difference in global work index (GWI) and global constructive work (GCW) between survivors and non-survivors on day 1 and for GWI on day 3. GWI, GCW, and GWE strongly correlated with LVEF and GLS, while the relationship with global wasted work (GWW) was weaker. Conclusions To our knowledge, this is the first study to investigate MW in critical care patients presenting with sepsis. The observed decrease in GWE in non-survivors on day 3 was mostly due to an increase in GWW, for which there are several possible mechanistic explanations that are potential targets for future research or therapeutic intervention. Trial Registration Prospectively and publicly registered on the ISRCTN registry (23174569) on 12/04/2021.