title: Interval Changes in Myocardial Performance Index Predict Outcome in Severe Sepsis.
abstract: OBJECTIVE
  Septic cardiomyopathy is a well-described consequence of septic shock and is associated with increased sepsis-related mortality. The myocardial performance index (MPI), a parameter derived from echocardiographic tissue Doppler measurements, allows for a more sensitive assessment of global cardiac function than do traditional metrics for cardiac function. The authors hypothesized that changes in left ventricular MPI in patients with severe sepsis would be associated with a higher 90-day mortality.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Intensive care units of a tertiary medical center.
  
  
  METHODS
  The study comprised 47 patients admitted with new diagnoses of severe sepsis or septic shock.
  
  
  METHODS
  All patients underwent transthoracic echocardiograms with assessment of MPI at enrollment and 24 hours later. Hemodynamic data and information on sepsis-related mortality were collected. In the primary analysis, the association between change in MPI from enrollment to 24 hours and sepsis-related 90-day mortality was assessed.
  
  
  RESULTS
  Of the 47 patients enrolled, 30 demonstrated an improvement in MPI from 0 to 24 hours ("improved" group), and MPI worsened in the remaining 17 patients ("worsened" group). Despite no significant differences in ejection fraction or severity of illness, the median MPI at enrollment in the "improved" group was higher than baseline values in the "worsened" group (p = 0.005). A worsening MPI over the 24-hour study interval was associated with increased mortality at 90 days (p = 0.04), which remained significant (hazard ratio 3.72; 95% confidence interval 1.12-12.41; p = 0.03) after adjusting for severity of illness (Acute Physiology and Chronic Health Evaluation II score), intravenous fluids, and vasopressor use.
  
  
  CONCLUSIONS
  In patients admitted to the intensive care unit with a diagnosis of severe sepsis or septic shock, a worsening MPI during the first 24 hours after intensive care unit admission was associated with higher 90-day mortality.
authors.affiliation: Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
authors.forename: Junaid
authors.initials: J
authors.lastname: Nizamuddin
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Feroze
authors.initials: F
authors.lastname: Mahmood
authors.affiliation: Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
authors.forename: Avery
authors.initials: A
authors.lastname: Tung
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Ariel
authors.initials: A
authors.lastname: Mueller
authors.affiliation: Pulmonary and Critical Care Medicine, Intermountain Medical Center, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Brown
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Shaefi
authors.affiliation: Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: O'Connor
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Talmor
authors.affiliation: Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL. Electronic address: sajid.shahul@gmail.com.
authors.forename: Sajid
authors.initials: S
authors.lastname: Shahul
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000401:mortality; D004452:Echocardiography / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018805:Sepsis / Q000000981:diagnostic imaging* / Q000401:mortality*; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome
keywords: cardiomyopathy; echocardiography; mortality; myocardial performance index; outcome; sepsis; septic cardiomyopathy; shock