Sepsis ICU Study Will Track Myocardial Work Across the First 84 Hours
A prospective cohort at Shanghai Zhongshan Hospital will follow adults with sepsis through the earliest phase of intensive care, using serial echocardiography to map how left ventricular myocardial performance changes over time. The study is designed to enroll 215 patients and will examine whether distinct trajectories of global work efficiency, or GWE, line up with clinical recovery measured as organ support-free days through day 28.
The focus is clinically sharp. Sepsis can disrupt myocardial function through a mix of inflammation, vasoplegia, changing preload and afterload, and fluctuating vasoactive support, all of which can make routine echocardiographic measures difficult to interpret at the bedside. Left ventricular ejection fraction and global longitudinal strain remain useful, but both are heavily load dependent in the unstable ICU environment. Myocardial work analysis attempts to reduce that problem by combining strain data with an estimated left ventricular pressure curve, generating pressure-strain loops and derived indices such as global work index, GWI, global constructive work, GCW, global wasted work, GWW, and GWE.
The planned assessments are timed to capture the most volatile phase of septic physiology. Echocardiographic and synchronized hemodynamic measurements will be collected in three windows: 0 to 12 hours after ICU admission, 20 to 28 hours, and 60 to 84 hours. Those repeated measurements matter because septic myocardial performance can shift quickly as fluid resuscitation, vasopressor titration, and source control reshape loading conditions and circulatory stress.
One sentence frames the whole protocol: myocardial behavior in sepsis will not be treated as static.
All treatment decisions will remain under the control of the clinical team, and the study-derived myocardial work measurements will not guide management. That design keeps the project observational and preserves routine care, while still allowing investigators to compare biomarker-like imaging trajectories with downstream outcomes. No additional blood sampling or extra arterial catheter placement will be required, which makes the protocol easier to embed in routine ICU practice.
Why Myocardial Work May Offer a More Stable View of Septic Cardiac Dysfunction
The rationale for the study rests on a persistent problem in critical care cardiology: conventional measures often blur when vascular tone and loading conditions are changing by the hour. In sepsis, a deceptively normal ejection fraction can coexist with impaired contractile reserve, while a reduced strain value may reflect altered afterload rather than intrinsic myocardial injury. Myocardial work was developed to address that ambiguity by anchoring deformation to pressure, offering a more integrated estimate of mechanical efficiency.
Within that framework, GWE may be especially informative. A low efficiency score suggests that more myocardial effort is being wasted rather than converted into forward flow, a pattern that could reflect dyssynchrony, adverse loading, or sepsis-related myocardial depression. Serial measurement offers a chance to see whether early inefficiency resolves as shock improves or persists in a subgroup with worse organ recovery. The study will use group-based trajectory modeling or latent class growth analysis to explore one to three longitudinal classes of GWE, then test how stable those classes are with model diagnostics and patient-level bootstrap resampling.
The planned landmark analysis adds another layer of rigor. By restricting clinical association analyses to a prespecified 84-hour landmark population, the investigators can reduce bias from very early deaths or rapidly changing clinical status and then evaluate whether stable GWE trajectory classes relate to organ support-free days through day 28. Secondary analyses will also look at mortality, other organ support outcomes, and dynamic relationships between myocardial work indices and hemodynamic measurements.
This is not a treatment trial. It is a physiologic mapping study built to answer a more basic question: whether early serial myocardial work carries prognostic meaning in septic ICU patients beyond the usual bedside measures.
Enrollment Criteria Target a Typical Early ICU Sepsis Cohort
Eligibility is built around a fairly specific ICU population. Adults 18 years and older must meet Sepsis-3 criteria within 12 hours of ICU admission, defined by an acute increase in SOFA score of at least 2 points attributable to infection. Participants also need an arterial catheter already placed for clinical reasons, and they must be eligible for early echocardiographic acquisition within the first 12 hours, even if the initial image set is technically imperfect.
Several exclusions protect the interpretability of the myocardial work readings. Patients admitted after cardiac surgery are excluded, as are those receiving mechanical circulatory support such as ECMO, an intra-aortic balloon pump, or Impella before enrollment. Moderate-to-severe aortic stenosis, significant left ventricular outflow tract obstruction, severe aortic regurgitation, severe mitral regurgitation, and other structural abnormalities that would distort myocardial work calculations are also exclusionary. Patients for whom care is limited to comfort measures only, pregnant patients, and those without a valid consent pathway are excluded as well.
The study population description signals a pragmatic ICU sample rather than a highly selected physiologic subset. Consecutive screening within 12 hours of ICU admission should help capture the early septic window when myocardial loading conditions are most unstable and when serial imaging may be most revealing.
A second direct point matters clinically: the protocol depends on routine care infrastructure already in place.
What This Study Could Clarify About Early Septic Cardiac Phenotypes
If the trajectory modeling identifies stable GWE classes, the study could help separate transient septic myocardial dysfunction from a more persistent inefficiency phenotype. That distinction would matter at the bedside because septic shock is not one cardiac state. Some patients may simply be under intense hemodynamic stress during the first day, while others may maintain a pattern of poor mechanical efficiency despite resuscitation and support.
The broader implication is methodological as much as physiologic. ICU cardiology still leans heavily on single time-point echocardiograms, even though sepsis evolves rapidly and often nonlinearly. Serial myocardial work may offer a way to describe that evolution in a more coherent format, linking mechanical efficiency to clinical recovery rather than treating each echo as an isolated snapshot. If the association with organ support-free days is strong, the findings could support future studies that test whether myocardial work trajectories can refine risk stratification or better phenotype septic cardiomyopathy.
For now, the study remains in the planning stage. The estimated start date is January 1, 2027, and both primary and study completion are estimated for December 31, 2029. No results are posted yet, and the main question remains whether early myocardial work patterns in sepsis are reproducible enough to become a useful prognostic signal in routine ICU care.