Isolated and reversible impairment of ventricular relaxation in patients with septic shock.
OBJECTIVE
Many patients with septic shock and increased cardiac troponin I (cTnI) do not exhibit significant left ventricular systolic dysfunction. We hypothesized that an isolated and reversible impairment of ventricular relaxation may be associated with the increase in cTnI.


METHODS
Prospective, observational study.


METHODS
Surgical intensive care unit in a university hospital.


METHODS
Total of 54 patients with septic shock.


METHODS
Fractional area change, early diastolic velocity of mitral annulus, flow propagation velocity of early diastolic mitral inflow, cTnI, tumor necrosis factor-alpha, interleukin (IL)-6, -1beta, -8, and -10 were measured at days 1, 2, 3, 4, 7, and 10 after onset of septic shock. Patients were classified into three groups: normal cTnI (group 1), increased cTnI and fractional area change <50% (group 2), and increased cTnI and fractional area change >50% (group 3).


RESULTS
A total of 22 patients had an increase in cTnI, 11 with both systolic and diastolic dysfunctions and 11 with isolated impairment of left ventricular relaxation. At day 1, early diastolic velocity of mitral annulus and flow propagation velocity of early diastolic mitral inflow were significantly lower and tumor necrosis factor-alpha, IL-8, and IL-10 significantly higher in groups 2 and 3 compared with group 1. With resolution of septic shock, early diastolic velocity of mitral annulus and flow propagation velocity of early diastolic mitral inflow measured in patients of groups 2 and 3 returned progressively to values observed in group 1, with a parallel normalization of tumor necrosis factor-alpha, IL-8, and IL-10.


CONCLUSIONS
Isolated and reversible impairment of left ventricular relaxation, associated with transient increases in cTnI, tumor necrosis factor-alpha, IL-8, and IL-10, was observed in 20% of patients with septic shock.
Bouhemad
Bélaïd
B
Réanimation Chirurgicale Pierre Viars, Department of Anesthesiology, Assistance Publique Hôpitaux de Paris, Hospital Pitié-Salpêtrière, University Pierre et Marie Curie, Paris-6, France.
Nicolas-Robin
Armelle
A
Arbelot
Charlotte
C
Arthaud
Martine
M
Féger
Frédéric
F
Rouby
Jean-Jacques
JJ
D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011446:Prospective Studies; D012772:Shock, Septic / Q000503:physiopathology*