Original article
Clinical Spectrum, Frequency, and Significance of Myocardial Dysfunction in Severe Sepsis and Septic Shock

https://doi.org/10.1016/j.mayocp.2012.01.018Get rights and content

Abstract

Objective

To determine the frequency and spectrum of myocardial dysfunction in patients with severe sepsis and septic shock using transthoracic echocardiography and to evaluate the impact of the myocardial dysfunction types on mortality.

Patients and Methods

A prospective study of 106 patients with severe sepsis or septic shock was conducted from August 1, 2007, to January 31, 2009. All patients underwent transthoracic echocardiography within 24 hours of admission to the intensive care unit. Myocardial dysfunction was classified as left ventricular (LV) diastolic, LV systolic, and right ventricular (RV) dysfunction. Frequency of myocardial dysfunction was calculated, and demographic, hemodynamic, and physiologic variables and mortality were compared between the myocardial dysfunction types and patients without cardiac dysfunction.

Results

The frequency of myocardial dysfunction in patients with severe sepsis or septic shock was 64% (n=68). Left ventricular diastolic dysfunction was present in 39 patients (37%), LV systolic dysfunction in 29 (27%), and RV dysfunction in 33 (31%). There was significant overlap. The 30-day and 1-year mortality rates were 36% and 57%, respectively. There was no difference in mortality between patients with normal myocardial function and those with left, right, or any ventricular dysfunction.

Conclusion

Myocardial dysfunction is frequent in patients with severe sepsis or septic shock and has a wide spectrum including LV diastolic, LV systolic, and RV dysfunction types. Although evaluation for the presence and type of myocardial dysfunction is important for tailoring specific therapy, its presence in patients with severe sepsis and septic shock was not associated with increased 30-day or 1-year mortality.

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.

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