Right ventricular functions in sepsis and septic shock: relation to risk stratification and short-term outcomes

Abstract

Background: Sepsis-induced cardiac dysfunction (SICD) is common in sepsis and septic shock. Although traditionally focused on left ventricular dysfunction, right ventricular (RV) impairment may have important prognostic value. This study evaluated the relationship between RV performance and severity and outcome in sepsis and septic shock.

Methods: This prospective cohort study included 50 adults admitted to the Critical Care Medicine Unit, Mansoura University Hospitals, between June 2024 and June 2025 with sepsis or septic shock. Transthoracic echocardiography was performed within 12 hours of admission and repeated during follow-up for up to 7 days. RV assessment included tissue Doppler-derived tricuspid annular systolic velocity (TV S′), tricuspid E/e′ ratio, RV myocardial performance index (MPI), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), and TAPSE/PASP ratio. Patients were classified by sepsis severity and survival status. The primary outcome was in-hospital mortality; the secondary outcome was intensive care unit length of stay.

Results: Septic shock was associated with lower TAPSE (P = 0.015), TAPSE/PASP ratio (P = 0.003), and TV S′ (P = 0.009), and higher RV MPI (P = 0.001) and TV E/e′ (P = 0.007). Baseline TV S′, TAPSE, and TAPSE/PASP were comparable between survivors and non-survivors, but decreased significantly during follow-up in non-survivors (P = 0.001 for each). Non-survivors also showed increasing RV filling pressures, lactate, neutrophil-to-lymphocyte ratio, and troponin (P ≤ 0.005).

Conclusions: RV dysfunction, particularly reduced TAPSE/PASP ratio, lower TV S′, and higher RV MPI, provides clinically relevant prognostic information for septic shock progression and short-term mortality.

Keywords: Echocardiography; Myocardial performance index; Sepsis-induced cardiac dysfunction; Sepsis; Septic shock; Right ventricular dysfunction; Tissue Doppler imaging

Abbreviations: MPI: myocardial performance index, RV: right ventricular, SICD: Sepsis-induced cardiac dysfunction. TAPSE: tricuspid annular plane systolic excursion

Citation: El-Shimy AA, Hafez AA, Gouda TES, Mousa SA. Right ventricular functions in sepsis and septic shock: relation to risk stratification and short-term outcomes. Anaesth. pain intensive care 2026;30(3):669-683. DOI: 10.35975/apic.v30i6.3262

Received: May 14, 2026; Revised: June 10, 2026; Accepted: June 10, 2026