title: Left ventricular systolic dysfunction during septic shock: the role of loading conditions.
abstract: OBJECTIVE
  The clinical significance of septic myocardial dysfunction is controversial, a fact that may be explained by the influence of loading conditions. Many indices may be useful to characterize cardiac function during septic shock, but their feasibility and physiological coherence in the clinical setting are unknown.
  
  
  METHODS
  Hemodynamic and echocardiographic data with tissue Doppler and speckle tracking were prospectively recorded on the first 3 days of human septic shock. Hypokinesia, normokinesia, and hyperkinesia were defined as a left ventricular ejection fraction (LVEF) of <45, 45-60, and >60%, respectively. Twelve hemodynamic indices exploring contractility and loading conditions were assessed and analyzed.
  
  
  RESULTS
  Two hundred and ninety-seven echocardiographies were performed in 132 patients. During the first 24 h (H1-24), 48 (36.4%) patients were hyperkinetic, 55 (41.7%) were normokinetic, and 29 (22.0%) patients were hypokinetic. Thirteen patients had a secondary hypokinesia absent at H1-24but present at H25-48or H49-72, for an overall incidence of 42 (31.8%) during the first 3 days. Despite a limited feasibility (<50%), global LV longitudinal peak systolic strain was impaired in a majority (>70%) of the patients assessed, including all those with depressed LVEF, and declined early in patients whose LVEF secondarily deteriorated. Most contractility indices were inversely correlated with afterload indices. Hyperkinetic patients exhibited the worst reduction in afterload indices. Hospital mortality was significantly higher in patients with LV hyperkinesia than in their counterparts: 30 (62.5%) vs. 35 (41.7%), p = 0.02.
  
  
  CONCLUSIONS
  Speckle tracking-derived strain was reduced in the majority of patients with septic shock, revealing covert septic myocardial dysfunction, but had poor feasibility. We found an inverse correlation between most of the contractility and afterload indices. Precise evaluation of afterload is crucial for adequate interpretation of LV systolic function in this setting.
authors.affiliation: AP-HP, Hôpitaux universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.|Université Paris Est Créteil, Faculté de Médecine de Créteil, IMRB, GRC CARMAS, 94010, Créteil, France.|CHU de Poitiers, Réanimation médicale, Poitiers, France.|INSERM CIC 1402 (ALIVE group) Université de Poitiers, Poitiers, France.
authors.forename: Florence
authors.identifier: http://orcid.org/0000-0002-9745-4783
authors.initials: F
authors.lastname: Boissier
authors.affiliation: AP-HP, Hôpitaux universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.|Université Paris Est Créteil, Faculté de Médecine de Créteil, IMRB, GRC CARMAS, 94010, Créteil, France.
authors.forename: Keyvan
authors.initials: K
authors.lastname: Razazi
authors.affiliation: AP-HP, Hôpitaux universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.|AP-HP, Hôpitaux universitaires Henri Mondor, Service de Cardiologie, 94010, Créteil, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Seemann
authors.affiliation: AP-HP, Hôpitaux universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.|Université Paris Est Créteil, Faculté de Médecine de Créteil, IMRB, GRC CARMAS, 94010, Créteil, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Bedet
authors.affiliation: AP-HP, Hôpitaux universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.|CHU de Poitiers, Réanimation médicale, Poitiers, France.|INSERM CIC 1402 (ALIVE group) Université de Poitiers, Poitiers, France.
authors.forename: Arnaud W
authors.initials: AW
authors.lastname: Thille
authors.affiliation: AP-HP, Hôpitaux universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.|Université Paris Est Créteil, Faculté de Médecine de Créteil, IMRB, GRC CARMAS, 94010, Créteil, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: de Prost
authors.affiliation: AP-HP, Hôpitaux universitaires Henri Mondor, Service de Cardiologie, 94010, Créteil, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Lim
authors.affiliation: AP-HP, Hôpitaux universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.|Université Paris Est Créteil, Faculté de Médecine de Créteil, IMRB, GRC CARMAS, 94010, Créteil, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
authors.affiliation: AP-HP, Hôpitaux universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France. armand.dessap@aphp.fr.|Université Paris Est Créteil, Faculté de Médecine de Créteil, IMRB, GRC CARMAS, 94010, Créteil, France. armand.dessap@aphp.fr.|Service de Réanimation Médicale, CHU Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France. armand.dessap@aphp.fr.
authors.forename: Armand
authors.initials: A
authors.lastname: Mekontso Dessap
mesh_terms: D000368:Aged; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D006801:Humans; D018476:Hypokinesia; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012772:Shock, Septic / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*
keywords: Afterload; Cardiac dysfunction; Sepsis