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

Abstract

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.

Characterizing the relationship between systemic inflammatory response syndrome and early cardiac dysfunction in traumatic brain injury

“…Systolic dysfunction improved in the cohort over the first week following injury, while SIRS was still present in more than half of the patients. This is different from patterns of sepsis‐induced cardiac dysfunction, which typically begins with a hyperdynamic response, followed by hypokinesis and decreased ventricular function, which remains for 7 to 10 days (Boissier et al, ; Huang, Nalos, & McLean, ), indicating that systolic dysfunction in our patients was likely not due to sepsis. Although admission SIRS was associated with systolic dysfunction, SIRS on the first day was not.…”

Cardiovascular focus editorial ICM 2018

“…This agenda builds on the previous expert round table statement and in particular underlines the importance of certification processes, advanced forms of training with simulation software and new ultrasonography techniques [5]. In regards to the latter, the use of left ventricular strain and strain rate was distinctly different in patients with septic cardiomyopathy, but only feasible in about 40% of patients [4]. Future important trials include the use of critical care ultrasonography instead of more complex and expensive imaging systems in resource limited settings, for example the use of lung ultrasonography to replace chest radiography and potentially chest computed tomography, and specific ultrasound-guided protocols for fluid resuscitation.…”

“…The end-systolic arterial elastance that could be assessed in 79% of patients was highly correlated with left ventricular ejection fraction and significantly higher in patients with early (within 24 h of septic shock) hypokinesia. The highest mortality in ICU and in-hospital were observed in patients with low arterial load and associated hyperkinesia [4].…”

“…An improved understanding and measure of arterial loading is likely to advance the debate on the clinical and prognostic relevance of septic myocardial dysfunction. The importance of arterial load was recently highlighted in a prospective, observational study of 132 septic patients investigated using repeated echocardiography during the first 3 days [4]. The end-systolic arterial elastance that could be assessed in 79% of patients was highly correlated with left ventricular ejection fraction and significantly higher in patients with early (within 24 h of septic shock) hypokinesia.…”

Norepinephrine improves cardiac function during septic shock, but why?

“…Myocardial depression is frequently present in patients with septic shock, but becomes evident in some patients only after the correction of hypotension. 3,4 Interestingly, nitric-oxide-synthase inhibition in septic shock restored arterial pressure, but decreased cardiac output and was associated with increased mortality. 5 Accordingly, it is thus crucial to determine the cardiovascular effects of norepinephrine in septic shock.…”