Acute left ventricular dilatation and shock-induced myocardial dysfunction*

Bouhemad, Bélaïd; Nicolas-Robin, Armelle; Arbelot, Charlotte; Arthaud, M; Féger, Frédéric; Rouby, Jean‐Jacques

doi:10.1097/ccm.0b013e318194ac44

Cited by 147 publications

(105 citation statements)

References 36 publications

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“…Echocardiographic studies have reported similar results with a reduced global systolic function in 30 to 60% of septic shock patients (23,35) and reversibility in survivors (26,28,102). The definition of systolic dysfunction has varied (LVEF 45 to 55%) and comparison between studies is therefore complicated.…”

Section: Echocardiographysupporting

confidence: 57%

Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

Geer

2016

Linköping University Medical Dissertations

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Background: Cardiac dysfunction is a well-known complication of sepsis, but its characteristics and consequences, especially on a longer term, remain unclear. The aim of this thesis was to study the characteristics and the implications of cardiac dysfunction for outcome in intensive care unit (ICU) patients with septic shock. Purpose: First, to assess the ability of a cardiac biomarker to predict outcome in ICU patients. Second, to characterise cardiac dysfunction in septic shock using speckle tracking echocardiography. Third, to investigate the reliability of echocardiographic methods used to describe cardiac dysfunction in septic shock. Fourth, to study long-term cardiac outcome in severe sepsis and septic shock patients. Materials and methods: The cardiac biomarker amino-terminal pro-brain natriuretic peptide (NTproBNP) was collected in 481 patients on ICU admission and its ability to predict death was assessed. In 50 patients with septic shock, echocardiography was performed on ICU admission and was repeated during and after ICU stay. Measurements of cardiac strain using speckle tracking echocardiography were assessed in relation to other echocardiographic function parameters, NT-proBNP and severity of illness scores, and their change over time was analysed. Echocardiograms from patients with septic shock were independently evaluated by two physicians and the results analysed regarding measurement variability. A nationwide-registry-based open cohort of 9,520 severe sepsis and septic shock ICU patients discharged alive from the ICU was analysed together with a non-septic control group matched for age, sex and severity of illness. In patients who died after ICU discharge, information on causes of death was collected. Results: A discriminatory level of significance of NT-proBNP on ICU admission was identified at ≥1,380 ng/L, above which NT-proBNP was an independent predictor of death. With increasing levels of NT-proBNP, patients were more severely ill, had a longer ICU stay and were more often admitted with septic shock. Cardiac strain was frequently impaired in septic shock patients but was not superior to other echocardiographic measurements in detecting cardiac dysfunction. Cardiac strain correlated with other echocardiographic function parameters and with NT-proBNP, and was the least user-dependent echocardiographic parameter in septic shock patients. Cardiac strain remained unchanged over time, did not differ between survivors and non-survivors and could not predict an increased risk of death. During a follow-up of up to nearly 6 years after ICU discharge, 3,954 (42%) of sepsis patients died, 654 (17%) with cardiac failure as the cause of death. With increasing severity of illness on admission, the risk of death with cardiac failure as the cause of death after ICU discharge increased. In comparison to other ICU patients with similar severity of illness, however, the risk of death due to cardiac was not increased in patients with severe sepsis or septic shock. Conclusions: Laboratory or echocardiographic si...

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Section: Echocardiographysupporting

confidence: 57%

Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

Geer

2016

Linköping University Medical Dissertations

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“…Despite the obvious importance of these echocardiographic findings, the presence of any myocardial dysfunction was not associated with increased mortality at 30 days or 1 year. 28,29 suggesting that LV diameters and volumes could be better markers of prognosis than LVEF. Arguably, this difference could be secondary to dis- crepancies in resuscitation and loading conditions; patients having less aggressive fluid resuscitation could demonstrate lower ventricular volumes, which could translate to poorer prognosis.…”

Section: Discussionmentioning

confidence: 99%

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

Pulido

Afessa

Miyamoto

et al. 2012

Mayo Clinic Proceedings

260

208

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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% (nϭ68). 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. M yocardial dysfunction in sepsis is one of the most complex organ failures to characterize because of the dynamic adaptation of the cardiovascular system to the disease process, host response, and resuscitation. The pathophysiology of this entity is complex and multifactorial. Systemic, extracellular, and cellular mechanisms have been described, including maldistribution of coronary blood flow, cytokine-induced (tumor necrosis factor ␣, interleukin 1␤, interleukin 6) neutrophil activation and myocardial injury, complement (C5a)-triggered myocyte contractile failure, calcium handling dysregulation, and cytopathic hypoxia due to mitochondrial dysfunction.

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“…16,20 We found a higher hs-cTnT level in non-survivors, compared to that of survivors. Furthermore, a previous study found higher hs-cTnT levels in septic vs. non-septic neonates [190 (120-320) pg/mL vs. 30 (0-7) pg/mL, respectively; (P < 0.0001)].…”

Section: Discussionmentioning

confidence: 67%

Ventricular function and high-sensitivity cardiac troponin T in preterm infants with neonatal sepsis

Ramadhina¹,

Sukardi²,

Advani³

et al. 2015

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Acute left ventricular dilatation and shock-induced myocardial dysfunction*

Abstract: Acute and reversible left ventricular dilation accompanies septic shock-induced systolic left ventricular dysfunction. When septic myocardial abnormalities are limited to reversible impairment of left ventricular relaxation, left ventricular dimensions remain unchanged.

Cited by 147 publications

References 36 publications

Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

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

Ventricular function and high-sensitivity cardiac troponin T in preterm infants with neonatal sepsis

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