title: Prognostic value of ventricular diastolic dysfunction in patients with severe sepsis and septic shock.
abstract: OBJECTIVE
  To evaluate the prevalence of myocardial dysfunction and its prognostic value in patients with severe sepsis and septic shock.
  
  
  METHODS
  Adult septic patients admitted to an intensive care unit were prospectively studied using transthoracic echocardiography within the first 48 hours after admission and thereafter on the 7th-10th days. Echocardiographic variables of biventricular function, including the E/e' ratio, were compared between survivors and non-survivors.
  
  
  RESULTS
  A total of 99 echocardiograms (53 at admission and 46 between days 7 - 10) were performed on 53 patients with a mean age of 74 (SD 13) years. Systolic and diastolic dysfunction was present in 14 (26%) and 42 (83%) patients, respectively, and both types of dysfunction were present in 12 (23%) patients. The E/e' ratio, an index of diastolic dysfunction, was the best predictor of hospital mortality according to the area under the ROC curve (0.71) and was an independent predictor of outcome, as determined by multivariate analysis (OR = 1.36 [1.05 - 1.76], p = 0.02).
  
  
  CONCLUSIONS
  In septic patients admitted to an intensive care unit, echocardiographic systolic dysfunction is not associated with increased mortality. In contrast, diastolic dysfunction is an independent predictor of outcome.
authors.affiliation: Instituto Médico de Alta Complejidad, Buenos Aires, Argentina.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Rolando
authors.affiliation: Sanatório Otamendi, Buenos Aires, Argentina.
authors.forename: Emilio Daniel Valenzuela
authors.initials: ED
authors.lastname: Espinoza
authors.affiliation: Sanatório Otamendi, Buenos Aires, Argentina.
authors.forename: Emelin
authors.initials: E
authors.lastname: Avid
authors.affiliation: Sanatório Otamendi, Buenos Aires, Argentina.
authors.forename: Sebastián
authors.initials: S
authors.lastname: Welsh
authors.affiliation: Sanatório Otamendi, Buenos Aires, Argentina.
authors.forename: Juan Del
authors.initials: JD
authors.lastname: Pozo
authors.affiliation: Sanatório Otamendi, Buenos Aires, Argentina.
authors.forename: Alejandro Risso
authors.initials: AR
authors.lastname: Vazquez
authors.affiliation: Sanatório Otamendi, Buenos Aires, Argentina.
authors.forename: Yanina
authors.initials: Y
authors.lastname: Arzani
authors.affiliation: Sanatório Otamendi, Buenos Aires, Argentina.
authors.forename: Fabio Daniel
authors.initials: FD
authors.lastname: Masevicius
authors.affiliation: Sanatório Otamendi, Buenos Aires, Argentina.
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Dubin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications* / Q000401:mortality; D012772:Shock, Septic / Q000150:complications* / Q000401:mortality; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology