title: Left ventricular torsion abnormalities in septic shock and corrective effect of volume loading: a pilot study.
abstract: BACKGROUND
  Ventricular torsion is an important component of cardiac function. The effect of septic shock on left ventricular torsion is not known. Because torsion is influenced by changes in preload, we compared the effect of fluid loading on left ventricular torsion in septic shock with the response in matched healthy control subjects.
  
  
  METHODS
  We assessed left ventricular torsion parameters using transthoracic echocardiography in 11 patients during early septic shock and in 11 age- and sex-matched healthy volunteers before and after rapid volume loading with 250 mL of a Ringer's lactate solution.
  
  
  RESULTS
  Peak torsion and peak apical rotation were reduced in septic shock (10.2 ± 5.2° and 5.6 ± 5.4°) compared with healthy volunteers (16.3 ± 4.5° and 9.6 ± 1.5°; P = 0.009 and P = 0.006 respectively). Basal rotation was delayed and diastolic untwisting velocity reached its maximum later during diastole in septic shock patients than in healthy volunteers (104 ± 16% vs 111 ± 14% and 13 ± 5% vs 21 ± 10%; P = 0.03 and P = 0.034, respectively). Fluid challenge increased peak torsion in both groups (septic shock, 10.2 ± 5.3° vs 12.6 ± 3.9°; healthy volunteers, 16.3 ± 4.5° vs 18.1 ± 6°; P = 0.01). Fluid challenge increased left ventricular stroke volume in septic shock patients (P = 0.003).
  
  
  CONCLUSIONS
  Compared with healthy volunteers, left ventricular torsion is impaired in septic shock patients. Fluid loading attenuates torsion abnormalities in parallel with increasing stroke volume. Reduced torsional motion might constitute a relevant component of septic cardiomyopathy, a notion that merits further testing in larger populations.
authors.affiliation: Department of Intensive Care Medicine, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland; Department of Cardiology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland. Electronic address: Stefan.Bloechlinger@insel.ch.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bloechlinger
authors.forename: David
authors.initials: D
authors.lastname: Berger
authors.forename: Jürg
authors.initials: J
authors.lastname: Bryner
authors.forename: Jan
authors.initials: J
authors.lastname: Wiegand
authors.forename: Martin W
authors.initials: MW
authors.lastname: Dünser
authors.forename: Jukka
authors.initials: J
authors.lastname: Takala
mesh_terms: D000328:Adult; D000368:Aged; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D012772:Shock, Septic / Q000000981:diagnostic imaging / Q000628:therapy*; D013318:Stroke Volume / Q000502:physiology; D013557:Switzerland; D013599:Systole / Q000502:physiology; D014102:Torsion Abnormality / Q000000981:diagnostic imaging / Q000628:therapy*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000628:therapy*