title: The prognostic value of left ventricular systolic function measured by tissue Doppler imaging in septic shock.
abstract: BACKGROUND
  Left ventricular (LV) dysfunction is common in septic shock. Its association with the clinical outcome is still controversial. Tissue Doppler imaging (TDI) is a useful tool to quantify LV function; however, little knowledge is available about the prognostic value of these TDI variables in septic shock. Therefore, we performed this prospective study to determine the role of TDI variables in septic shock.
  
  
  METHODS
  Patients with septic shock in a medical intensive care unit were studied with transthoracic echocardiography with TDI within 24 hours after the onset of septic shock. Baseline clinical, laboratory, and echocardiographic variables were prospectively collected. Independent predictors of 90-day mortality were analyzed with the Cox regression model.
  
  
  RESULTS
  During a 20-month period, 61 patients were enrolled in the study. The 90-day mortality rate was 39%; the mean APACHE IV score was 84 (68 to 97). Compared with survivors, nonsurvivors exhibited significantly higher peak systolic velocity measured at the mitral annulus (Sa) (11.0 (9.1 to 12.5) versus 7.8 (5.5 to 9.0) cm/sec; P < 0.0001), lower PaO2/FiO2 (123 (83 to 187) versus 186 (142 to 269) mm Hg; P = 0.002], higher heart rate (120 (90 to 140) versus 103 (90 to 114) beats/min; P = 0.004], and a higher dose of norepinephrine (0.6 (0.2 to 1.0) versus 0.3 (0.2 to 0.5) μg/kg/min; P = 0.007]. In the multivariate analysis, Sa > 9 cm/sec (hazard ratio (HR), 5.559; 95% confidence interval (CI), 2.160 to 14.305; P < 0.0001), dose of norepinephrine (HR, 1.964; 95% CI, 1.338 to 2.883; P = 0.001), and PaO2/FiO2 (HR, 0.992; 95% CI, 0.984 to 0.999; P = 0.031) remain independent predictors of 90-day mortality in septic-shock patients.
  
  
  CONCLUSIONS
  Our study demonstrated that LV systolic function as determined by TDI, in particular, Sa, might be associated with mortality in patients with septic shock.
authors.forename: Li
authors.initials: L
authors.lastname: Weng
authors.forename: Yong-tai
authors.initials: YT
authors.lastname: Liu
authors.forename: Bin
authors.initials: B
authors.lastname: Du
authors.forename: Jian-fang
authors.initials: JF
authors.lastname: Zhou
authors.forename: Xiao-xiao
authors.initials: XX
authors.lastname: Guo
authors.forename: Jin-min
authors.initials: JM
authors.lastname: Peng
authors.forename: Xiao-yun
authors.initials: XY
authors.lastname: Hu
authors.forename: Shu-yang
authors.initials: SY
authors.lastname: Zhang
authors.forename: Quan
authors.initials: Q
authors.lastname: Fang
authors.forename: Wen-ling
authors.initials: WL
authors.lastname: Zhu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011379:Prognosis; D011446:Prospective Studies; D012772:Shock, Septic / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology