Abstract
Objective
To determine the frequency and spectrum of myocardial dysfunction in patients with
severe sepsis and septic shock using transthoracic echocardiography and to evaluate
the impact of the myocardial dysfunction types on mortality.
Patients and Methods
A prospective study of 106 patients with severe sepsis or septic shock was conducted
from August 1, 2007, to January 31, 2009. All patients underwent transthoracic echocardiography
within 24 hours of admission to the intensive care unit. Myocardial dysfunction was
classified as left ventricular (LV) diastolic, LV systolic, and right ventricular
(RV) dysfunction. Frequency of myocardial dysfunction was calculated, and demographic,
hemodynamic, and physiologic variables and mortality were compared between the myocardial
dysfunction types and patients without cardiac dysfunction.
Results
The frequency of myocardial dysfunction in patients with severe sepsis or septic shock
was 64% (n=68). Left ventricular diastolic dysfunction was present in 39 patients
(37%), LV systolic dysfunction in 29 (27%), and RV dysfunction in 33 (31%). There
was significant overlap. The 30-day and 1-year mortality rates were 36% and 57%, respectively.
There was no difference in mortality between patients with normal myocardial function
and those with left, right, or any ventricular dysfunction.
Conclusion
Myocardial dysfunction is frequent in patients with severe sepsis or septic shock
and has a wide spectrum including LV diastolic, LV systolic, and RV dysfunction types.
Although evaluation for the presence and type of myocardial dysfunction is important
for tailoring specific therapy, its presence in patients with severe sepsis and septic
shock was not associated with increased 30-day or 1-year mortality.
Abbreviations and Acronyms:
APACHE (Acute Physiology and Chronic Health Evaluation), Fio2 (fraction of inspired oxygen), LV (left ventricular), LVEF (left ventricular ejection fraction), Pao2 (partial pressure of arterial oxygen), RV (right ventricular), SOFA (Sequential Organ Failure Assessment)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: June 11, 2012
Footnotes
Grant Support: This study was funded by the Mayo Clinic Critical Care Research Committee.
Identification
Copyright
© 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
