title: Septic cardiomyopathy: hemodynamic quantification, occurrence, and prognostic implications.
abstract: BACKGROUND
  In sepsis, severe reduction of afterload may often mask cardiac impairment. By establishing the parameter "afterload-related cardiac performance (ACP)" we wanted to determine the extent, frequency, and prognostic relevance of septic cardiomyopathy.
  
  
  METHODS
  Over a 12 months period, all patients of our medical intensive care ward were included into the study when they were classified as having "septic MODS" (sepsis score ≥12 as long as APACHE II score was ≥20). Hemodynamic assessments were performed using a pulmonary artery catheter.
  
  
  RESULTS
  A total of 524 patients were screened, and from these 39 had septic MODS. In survivors, APACHE II score values declined from day 0 (day of diagnosis, 27.6 ± 8.0) to day 4 (17.8 ± 8.0), while in non-survivors, score values remained high (day 0: 31.8 ± 5.7; day 4: 33.2 ± 6.7; p < 0.001). Hemodynamic measurements showed an inverse correlation of cardiac output (CO(measured)) and SVR which can be described as CO = β (0) × SVR( β1). The upper limit of 80% tolerance range of CO was defined as the "normal" CO values (CO(normal)). The parameter "afterload-related cardiac performance (ACP)" was calculated as ACP (%) = CO(measured)/CO(normal) × 100. It turned out that ACP shows a stronger correlation with APACHE II- and sepsis-score than CO, cardiac index (CI), cardiac power (CPO), or cardiac power index (CPI). Furthermore, ACP correlated with sepsis-induced myocardial damage as indicated by elevations of troponin I and significantly differed between surviving (86.9 ± 1.6%) and non-surviving patients (69.2 ± 1.4%; p < 0.0001). While 75% of the surviving patients showed an ACP >60%, 38% of the non-survivors had a moderate (ACP 40-60%) and 25% a severe impairment of cardiac function (ACP < 40%).
  
  
  CONCLUSIONS
  By using the parameter "afterload-related cardiac performance, ACP", the impairment of cardiac function can be reliably quantified showing that septic cardiomyopathy occurs frequently and is of prognostic relevance in patients with septic MODS.
authors.affiliation: Department of Medicine III, University of Halle (Saale), Ernst-Grube-Street 40, 06097, Halle, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
authors.forename: Anja
authors.initials: A
authors.lastname: Oelke
authors.forename: Stefan
authors.initials: S
authors.lastname: Hettwer
authors.forename: Sebastian
authors.initials: S
authors.lastname: Nuding
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bubel
authors.forename: Robert
authors.initials: R
authors.lastname: Hoke
authors.forename: Martin
authors.initials: M
authors.lastname: Russ
authors.forename: Christine
authors.initials: C
authors.lastname: Lautenschläger
authors.forename: Ursula
authors.initials: U
authors.lastname: Mueller-Werdan
authors.forename: Henning
authors.initials: H
authors.lastname: Ebelt
mesh_terms: D018806:APACHE; D002302:Cardiac Output / Q000502:physiology; D009202:Cardiomyopathies / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D019210:Troponin I / Q000097:blood; D014655:Vascular Resistance / Q000502:physiology
chemical_list: D019210:Troponin I