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01-05-2017 | Original

Left ventricular systolic dysfunction during septic shock: the role of loading conditions

Authors: Florence Boissier, Keyvan Razazi, Aurélien Seemann, Alexandre Bedet, Arnaud W. Thille, Nicolas de Prost, Pascal Lim, Christian Brun-Buisson, Armand Mekontso Dessap

Published in: Intensive Care Medicine | Issue 5/2017

Abstract

Purpose

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 (H_1–24), 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 H_1–24 but present at H_25–48 or H_49–72, 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.

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Title: Left ventricular systolic dysfunction during septic shock: the role of loading conditions
Authors: Florence Boissier
Keyvan Razazi
Aurélien Seemann
Alexandre Bedet
Arnaud W. Thille
Nicolas de Prost
Pascal Lim
Christian Brun-Buisson
Armand Mekontso Dessap
Publication date: 01-05-2017
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 5/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-017-4698-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Left ventricular systolic dysfunction during septic shock: the role of loading conditions

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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