Original articleClinical Spectrum, Frequency, and Significance of Myocardial Dysfunction in Severe Sepsis and Septic Shock
Section snippets
Patients and Methods
This prospective study was approved by the Institutional Review Board of Mayo Clinic, and written informed consent was obtained from all patients or legally authorized representatives before enrollment.
Patients admitted to 3 adult intensive care units (ICUs) with a total of 62 beds at Mayo Clinic in Rochester, Minnesota, with severe sepsis or septic shock were eligible to participate in the study from August 1, 2007, to January 31, 2009. The characteristics of these ICUs have been previously
Results
A total of 106 patients were enrolled. The mean ± SD age was 65±15 years, and 53 patients (50%) were female. Documented microbial infection with positive source cultures was present in 53 patients (50%), and 36% of the study population had positive blood culture results.
The frequency of any myocardial dysfunction was 64% (n=68). Left ventricular diastolic dysfunction was found in 39 patients (37%), LV systolic dysfunction in 29 (27%), and RV dysfunction in 33 (31%) (Figure, A). Thirty-eight
Discussion
We found that myocardial dysfunction is common in severe sepsis and septic shock, affecting 64% of patients. With standard echocardiography, these abnormalities can be further divided into LV diastolic (37% of all patients), LV systolic (27%), and RV dysfunction (31%), which demonstrates the importance of going beyond LVEF when categorizing myocardial dysfunction in sepsis. There was significant overlap between the different types, as well as a wide range of severity within the groups (Figure).
Conclusion
Myocardial dysfunction is frequent in patients with severe sepsis and septic shock and presents in a wide spectrum including LV diastolic, LV systolic, and/or RV dysfunction. Decreased LVEF as the sole criterion for diagnosis of myocardial dysfunction in sepsis is inaccurate and misleading. We found no difference in mortality at 30 days or 1 year between patients with any myocardial dysfunction and patients with normal results on echocardiography. Despite these findings, echocardiography is a
Acknowledgments
We thank Melissa Passe, RRT, Richard Hinds, RRT, and the Anesthesia Clinical Research Unit personnel who were instrumental in patient recruitment and the Mayo Clinic Echocardiography Laboratory for allowing the use of the echocardiography instruments.
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Grant Support: This study was funded by the Mayo Clinic Critical Care Research Committee.