Left ventricular systolic and diastolic function in septic shock |
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Authors: | J Poelaert C Declerck D Vogelaers F Colardyn C A Visser |
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Institution: | (1) Department of Intensive Care Unit, University Hospital, De Pintelaan 185, B-9000 Gent, Belgium FAX: +32 (9) 240 4995, BE;(2) Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands, NL |
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Abstract: | Summary
Objective: The identification of myocardial dysfunction in septic shock has not yet been fully elucidated. We therefore studied patients
with persistently vasopressor-dependent septic shock, both with invasive haemodynamic monitoring and transoesophageal two-dimensional
and Doppler echocardiography (TEE). Design: Prospective study. Setting: General ICU in University Hospital. Patients and methods: All patients were monitored with arterial and pulmonary artery catheters. Haemodynamics were obtained concomitantly with
TEE measurements. TEE was performed at three levels: a) a midpapillary short axis view of the left ventricle (LV) in order
to measure end-systolic and end-diastolic areas; b) at the level of both the mitral valve for early (E) and late (A) filling
parameters and c) the level of the right upper pulmonary vein for systolic (S) and diastolic (D) filling characteristics.
Each parameter was characterised by maximal flow velocity and time velocity integral. Results: Although the measurements of cardiac index demonstrated a wide range, three subsets of patients were identified post hoc
after analysis on the basis of different Doppler patterns: first, patients with a LV without regional wall motion abnormalities
and both E/A and S/D greater than 1 (group 1); second, patients with a comparable haemodynamic condition, apparently normal
LV systolic function but with altered Doppler patterns: S/D less than 1 in conjunction with E/A more than 1 (group 2); finally,
patients with compromised global LV systolic function, E/A less than 1 and S/D less than (group 3). Conclusions: Notwithstanding the known various interfering factors which limit the broad applicability of TEE to determine LV function
in septic shock, our data suggest that cardiac dysfunction in septic shock shows a continuum from isolated diastolic dysfunction
to both diastolic and systolic ventricular failure. These data strengthen the need of including the evaluation of pulmonary
venous Doppler parameters in each investigation in order to obtain supplementary information to interpret diastolic function
of the LV in septic shock patients.
Received: 29 February 1996 Accepted: 10 February 1997 |
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Keywords: | Sepsis Shock Cardiac function Echocardiography |
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