title: Early dynamic left intraventricular obstruction is associated with hypovolemia and high mortality in septic shock patients.
abstract: BACKGROUND
  Based on previously published case reports demonstrating dynamic left intraventricular obstruction (IVO) triggered by hypovolemia or catecholamines, this study aimed to establish: (1) IVO occurrence in septic shock patients; (2) correlation between the intraventricular gradient and volume status and fluid responsiveness; and (3) mortality rate.
  
  
  METHODS
  We prospectively analyzed patients with septic shock admitted to a general ICU over a 28-month period who presented Doppler signs of IVO. Clinical characteristics and hemodynamic parameters as well as echocardiographic data regarding left ventricular function, size, and calculated mass, and left ventricular outflow Doppler pattern and velocity before and after fluid infusions were recorded.
  
  
  RESULTS
  During the study period, 218 patients with septic shock were admitted to our ICU. IVO was observed in 47 (22%) patients. Mortality rate at 28 days was found to be higher in patients with than in patients without IVO (55% versus 33%, p < 0.01). Small, hypercontractile left ventricles (end-diastolic left ventricular surface 4.7 ± 2.1 cm(2)/m(2) and ejection fraction 82 ± 12%), and frequent pseudohypertrophy were found in these patients. A rise ≥12% in stroke index was found in 87% of patients with IVO, with a drop of 47% in IVO after fluid infusion.
  
  
  CONCLUSIONS
  Left IVO is a frequent event in septic shock patients with an important correlation with fluid responsiveness. The mortality rate was found to be higher in these patients in comparison with patients without obstruction.
authors.affiliation: General Intensive Care Unit, Elbeuf Intercommunal Hospital Center, Elbeuf, France. jean-louis.chauvet@chi-elbeuf-louviers.fr.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Chauvet
authors.affiliation: Service de Réanimation Médicale, CHU Sud 80054, cedex 1, France. sharieldash@yahoo.com.|LIM-09 Medical Research Laboratory in Experimental Pneumology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil. sharieldash@yahoo.com.
authors.forename: Shari
authors.initials: S
authors.lastname: El-Dash
authors.affiliation: General Intensive Care Unit, Elbeuf Intercommunal Hospital Center, Elbeuf, France. olivier.delastre@chi-elbeuf-louviers.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Delastre
authors.affiliation: General Intensive Care Unit, Elbeuf Intercommunal Hospital Center, Elbeuf, France. bernard.bouffandeau@chi-elbeuf-louviers.fr.
authors.forename: Bernard
authors.initials: B
authors.lastname: Bouffandeau
authors.affiliation: General Intensive Care Unit, Elbeuf Intercommunal Hospital Center, Elbeuf, France. dominique.jusserand@chi-elbeuf-louviers.fr.
authors.forename: Dominique
authors.initials: D
authors.lastname: Jusserand
authors.affiliation: General Intensive Care Unit, Elbeuf Intercommunal Hospital Center, Elbeuf, France. jean-baptiste.michot@chi-elbeuf-louviers.fr.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Michot
authors.affiliation: Heart Failure and pulmonary hypertension Clinic, Echo Core Lab, Cardiology Department, Charles Nicolle Hospital, Rouen University Hospital, Rouen, France. fabrice.bauer@chu-rouen.fr.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bauer
authors.affiliation: Service de Réanimation Médicale, CHU Sud 80054, cedex 1, France. maizel.julien@chu-amiens.fr.|INSERM U-1088, Jules Verne University of Picardie, Amiens, France. maizel.julien@chu-amiens.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Maizel
authors.affiliation: Service de Réanimation Médicale, CHU Sud 80054, cedex 1, France. Slama.michel@chu-amiens.fr.|INSERM U-1088, Jules Verne University of Picardie, Amiens, France. Slama.michel@chu-amiens.fr.
authors.forename: Michel
authors.initials: M
authors.lastname: Slama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005440:Fluid Therapy; D005602:France / Q000453:epidemiology; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D017052:Hospital Mortality; D006801:Humans; D020896:Hypovolemia / Q000401:mortality*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000401:mortality*; D013318:Stroke Volume; D014463:Ultrasonography; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging*