Clinical spectrum, frequency, and significance of myocardial dysfunction in severe sepsis and septic shock.
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.


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.


CONCLUSIONS
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.
Department of Anesthesiology, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA. pulido.juan@mayo.edu
Juan N
JN
Pulido
Bekele
B
Afessa
Mitsuru
M
Masaki
Toshinori
T
Yuasa
Shane
S
Gillespie
Vitaly
V
Herasevich
Daniel R
DR
Brown
Jae K
JK
Oh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications / Q000503:physiopathology*; D012772:Shock, Septic / Q000150:complications / Q000503:physiopathology*; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000453:epidemiology
D015415:Biomarkers