Assessment of right ventricular functions in patients with sepsis, severe sepsis and septic shock and its prognostic importance: A tissue Doppler study

Harmankaya, Atıf; Akıllı, Hakan; Gül, Mehmet; Akıllı, Nazire Belgin; Ergin, Mehmet; Arıbaş, Alpay; Cander, Başar

doi:10.1016/j.jcrc.2013.07.059

Cited by 39 publications

(32 citation statements)

References 27 publications

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“…Sepsis-related myocardial dysfunction is frequently seen in patients with severe sepsis and septic shock [ 1 – 3 ]. Left ventricular (LV) systolic and diastolic dysfunction have been extensively studied in these patients and have demonstrated a variable correlation with clinical outcomes [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…RV dysfunction is reported in 30–60% of all septic patients and is frequently associated with concomitant LV dysfunction [ 6 , 7 ]. With the increasing use and evolution of echocardiographic methods for assessment of RV function, such as semiquantitative RV size and performance, tissue Doppler imaging (TDI) and strain imaging, there is greater evidence of RV dysfunction occurring in sepsis [ 3 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic impact of isolated right ventricular dysfunction in sepsis and septic shock: an 8-year historical cohort study

Vallabhajosyula

Kumar

Pandompatam

et al. 2017

Ann. Intensive Care

139

137

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BackgroundEchocardiographic myocardial dysfunction is reported commonly in sepsis and septic shock, but there are limited data on sepsis-related right ventricular dysfunction. This study sought to evaluate the association of right ventricular dysfunction with clinical outcomes in patients with severe sepsis and septic shock.MethodsHistorical cohort study of adult patients admitted to all intensive care units at the Mayo Clinic from January 1, 2007 through December 31, 2014 for severe sepsis and septic shock, who had an echocardiogram performed within 72 h of admission. Patients with prior heart failure, cor-pulmonale, pulmonary hypertension and valvular disease were excluded. Right ventricular dysfunction was defined by the American Society of Echocardiography criteria. Outcomes included 1-year survival, in-hospital mortality and length of stay.ResultsRight ventricular dysfunction was present in 214 (55%) of 388 patients who met the inclusion criteria—isolated right ventricular dysfunction was seen in 100 (47%) and combined right and left ventricular dysfunction in 114 (53%). The baseline characteristics were similar between cohorts except for the higher mechanical ventilation use in patients with isolated right ventricular dysfunction. Echocardiographic findings demonstrated lower right ventricular and tricuspid valve velocities in patients with right ventricular dysfunction and lower left ventricular ejection fraction and increased mitral E/e′ ratios in patients with combined right and left ventricular dysfunction. After adjustment for age, comorbidity, illness severity, septic shock and use of mechanical ventilation, isolated right ventricular dysfunction was independently associated with worse 1-year survival—hazard ratio 1.6 [95% confidence interval 1.2–2.1; p = 0.002) in patients with sepsis and septic shock.ConclusionsIsolated right ventricular dysfunction is seen commonly in sepsis and septic shock and is associated with worse long-term survival.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic impact of isolated right ventricular dysfunction in sepsis and septic shock: an 8-year historical cohort study

Vallabhajosyula

Kumar

Pandompatam

et al. 2017

Ann. Intensive Care

139

137

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“…The number of studies on RV function in sepsis by conventional echocardiography is limited. Using American Society of Echocardiography criteria, an RV dysfunction has been described in septic shock . Furthermore, it was recently shown that the incidence of isolated right and combined right and left ventricular dysfunction in sepsis/septic shock were 47% and 53%, respectively …”

Section: Introductionmentioning

confidence: 99%

Impact of norepinephrine on right ventricular afterload and function in septic shock—a strain echocardiography study

Dalla

Bech‐Hanssen

Ricksten

2019

Acta Anaesthesiol Scand

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Septic shock is defined as a subset of sepsis, characterised by, after adequate volume resuscitation, the need of vasopressors in order to maintain a normal mean arterial pressure (MAP) ≥65 mmHg. 1Myocardial dysfunction is commonly seen in sepsis also involving the right ventricle (RV). The number of studies on RV function in sepsis by conventional echocardiography is limited. Using American Society of Echocardiography criteria, 2 an RV dysfunction has been described in septic shock. 3,4 Furthermore, it was recently shown that the incidence of isolated right and combined right and left ventricular dysfunction in sepsis/septic shock were 47% and 53%, respectively. 5Norepinephrine administration increases arterial pressure due to its vasoconstrictor effect and is recommended as the first-choice vasopressor in this group of patients. 6 Concerns have been raised regarding a potentially negative effect of norepinephrine on myocardial function due to a norepinephrine-induced increase in left ventricular (LV) afterload. 7 The RV afterload is frequently elevated Background: In this observational study, the effects of norepinephrine-induced changes in mean arterial pressure (MAP) on right ventricular (RV) systolic function, afterload and pulmonary haemodynamics were studied in septic shock patients. We hypothesised that RV systolic function improves at higher doses of norepinephrine/ MAP levels.Methods: Eleven patients with septic shock requiring norepinephrine after fluid resuscitation were included <24 hours after ICU arrival. Study enrolment and insertion of a pulmonary artery catheter was performed after written informed consent from the next of kin. Norepinephrine infusion was titrated to target mean arterial pressures (MAP) of 60, 75 and 90 mmHg in a random sequential order. At each target MAP, strain-and conventional echocardiographic-and pulmonary haemodynamic variables were measured. RV afterload was assessed as effective pulmonary arterial elastance, (E pa ) and pulmonary vascular resistance index, (PVRI). RV free wall peak strain was the primary end-point. Results:At highest compared to lowest norepinephrine dose/MAP level, RV free wall peak strain increased from −19% to −25% (32%, P = .003), accompanied by increased tricuspid annular plane systolic excursion (22%, P = .01). At the highest norepinephrine dose/MAP, RV end-diastolic area index (16%, P < .001), central venous pressure (38%, P < .001), stroke volume index (7%, P = .001), mean pulmonary artery pressure (19%, P < .001) and RV stroke work index (15%, P = .045) increased, with no effects on PVRI or E pa . Cardiac index did not change, assessed by thermodilution (P = .079) and echocardiography (P = .054). Conclusions:Higher doses of norepinephrine to a target MAP of 90 mm Hg improved RV systolic function while RV afterload was not affected. S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Dalla K, Bech-Hanssen O, RickstenS-E...

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“…Anatomical characteristics and hypoxia due to low perfusion make it difficult to compensate RV afterload increases as we observe in acute pulmonary injury increased pulmonary vascular resistance. [4,18]. Right ventricle dysfunction is associated with lower cardiac output, higher norepinephrine doses, higher troponin and lactate [16].…”

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confidence: 99%

Sildenafil attenuates pulmonary hypertension in acute porcine endotoxaemia

Kemper

Otsuki

Maia

et al. 2019

Preprint

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Background Pulmonary hypertension is a risk factor for morbidity and mortality in septic shock. Pulmonary hypertension increases the right ventricular afterload, which tends to reduce the right ventricular output, leading to right ventricular dysfunction. Sildenafil has been largely used in the treatment of pulmonary arterial hypertension, but its effects in sepsis are unknown. The aim of this study was to investigate the hypothesis that sildenafil is able to attenuate endotoxin-induced pulmonary hypertension in a porcine model. Further, we investigated the effects on hemodynamic and oxygenation functions. We also evaluated lung morphology and the effect on plasma cytokine and troponin response. Methods Twenty pigs in which endotoxeamia was induced through intravenous bacterial lipopolysaccharide endotoxin (LPS) infusion (4µg/kg/h) were randomly assigned to Control group (n=10) – which received saline solution; or to Sildenafil group (n=10) – which received sildenafil orally (100 mg) previous the endotoxeamia. Results LPS induced a significant pulmonary hypertension with an increase in pulmonary arterial pressure, pulmonary vascular resistance index, end-diastolic volume of the right ventricle and also a decrease in PaO2/FiO2. Pulmonary and systemic arterial pressures were significantly lower in the Sildenafil group and sildenafil prevented the LPS effect on the end-diastolic volume of the right ventricle. Sildenafil maintained oxygenation with superior PaO2/FiO2 and lower oxygen extraction rate, but had no effect on intrapulmonary shunt. All cytokines and troponin increased after LPS infusion in both groups similarly. The LPS induced lung lesions, but there were no intergroup differences in the histological scoring system. Conclusion Sildenafil attenuated endotoxin-induced pulmonary hypertension preserving right heart function and maintained oxygenation without effecting shunt fractioning. However, caution should be taken due to the potential systemic vasodilatory effect. Sildenafil did not attenuate lung lesions and did not presented an anti-inflammatory effect in a porcine model of endotoxaemia.

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Assessment of right ventricular functions in patients with sepsis, severe sepsis and septic shock and its prognostic importance: A tissue Doppler study

Cited by 39 publications

References 27 publications

Prognostic impact of isolated right ventricular dysfunction in sepsis and septic shock: an 8-year historical cohort study

Prognostic impact of isolated right ventricular dysfunction in sepsis and septic shock: an 8-year historical cohort study

Impact of norepinephrine on right ventricular afterload and function in septic shock—a strain echocardiography study

Sildenafil attenuates pulmonary hypertension in acute porcine endotoxaemia

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