title: Diastolic filling in human severe sepsis: an echocardiographic study.
abstract: OBJECTIVE
  To determine if nonsurvivors have a more abnormal pattern of left ventricular relaxation than survivors with severe sepsis.
  
  
  METHODS
  Prospective, observational, cohort study.
  
  
  METHODS
  Intensive care unit in a university-affiliated tertiary care hospital.
  
  
  METHODS
  Twenty-four adults with severe sepsis.
  
  
  METHODS
  None.
  
  
  RESULTS
  Baseline clinical and hemodynamic variables, Acute Physiology and Chronic Health Evaluation (APACHE) II scores and Doppler echocardiographic mitral inflow pattern (analyzed for normalized peak early filling rate [E/VTI, systolic volumes/sec], deceleration time [msec], and early to atrial filling velocity ratio [E/A]). There were seven deaths. The patients did not differ in baseline demographics, inotropic infusions, hemodynamic measurements or ventilatory settings or variables. Nonsurvivors had a more abnormal pattern of left ventricular relaxation (E/VTI, 4.7 [range 3.8 to 5.8] vs. 5.8 [range 3.8 to 8.9], p= .04; deceleration time, 235 [range 209 to 367] vs. 182 [range 155 to 255], p = .002). E/A showed a nonsignificant trend in the same direction (0.9 [range 0.8 to 1.6] vs. 1.2 [range 0.7 to 1.9], p = .12). In a multivariate analysis, deceleration time (p< .004) and APACHE II score (p < .02) were the only independent predictors of mortality.
  
  
  CONCLUSIONS
  Severe sepsis nonsurvivors have a more abnormal echocardiographic pattern of left ventricular relaxation than survivors.
authors.affiliation: University of British Columbia and Vancouver Hospital and Health Science Center, BC, Canada. bmunt@stpaulshosp.bc.ca
authors.forename: B
authors.initials: B
authors.lastname: Munt
authors.forename: J
authors.initials: J
authors.lastname: Jue
authors.forename: K
authors.initials: K
authors.lastname: Gin
authors.forename: J
authors.initials: J
authors.lastname: Fenwick
authors.forename: M
authors.initials: M
authors.lastname: Tweeddale
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D018805:Sepsis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D016277:Ventricular Function, Left