Efficacy of transthoracic echocardiography for diagnosing heart failure in septic shock.
BACKGROUND
Cardiac dysfunction occurs in up to 80% of patients with septic shock. Transthoracic echocardiography (TTE) is an ideal tool for the detailed characterization of cardiac function. Its feasibility is perceived to be poor in critically ill patients, but this has never been studied. To address this question, the authors evaluated the efficacy of TTE to diagnose heart failure in septic shock.


METHODS
This was a retrospective study. Patients admitted to the intensive care unit with septic shock and who had a TTE within 72 hours of intensive care unit admission were identified by a computer algorithm and validated by chart review. Echocardiography images were reviewed by a single cardiologist blinded to clinical outcomes. Clinical information was collected from patients' medical record.


RESULTS
Seventy-six patients met the studies' inclusion criteria. The feasibility of TTE to calculate left ventricular ejection fraction was 90% and to assess diastolic function was 74%. Significant mitral regurgitation or aortic stenosis was the most frequent impediments for the assessment of diastolic function. Seventy-four percent of all patients showed some type of cardiac dysfunction (left or right ventricular systolic dysfunction and/or left ventricular diastolic dysfunction). In regression analyses, TTE feasibility was not impacted by factors previously associated with poor image acquisition: high body mass index, mechanical ventilation, tachycardia, advanced age or high severity of illness.


CONCLUSIONS
This study demonstrated that TTE is a useful tool to assess myocardial function in critically ill patients and suggested its potential to assist in the management of patients with septic shock.
Divisions of Cardiovascular Medicine (ASB), Critical Care Medicine (CVG), and Pulmonary and Critical Care Medicine (MRN, JLH), Department of Medicine and Departments of Anesthesia (JLH) and Pharmacy (LM), Stanford University Hospital, Stanford, California.
Anne-Sophie
AS
Beraud
Cristina Vazquez
CV
Guillamet
Jessie L
JL
Hammes
Lina
L
Meng
Mark R
MR
Nicolls
Joe L
JL
Hsu
D000368:Aged; D000369:Aged, 80 and over; D018619:Echocardiography, Doppler, Pulsed; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012772:Shock, Septic / Q000150:complications / Q000000981:diagnostic imaging*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging