Myocardial dysfunction in sepsis studied with the pressure recording analytical method

Introduction

Myocardial dysfunction is one of the most common organ failures in patients with sepsis characterized by transient biventricular contractility impairment, as well as systolic and diastolic dysfunction. The aim of this study is to value early hemodynamic alterations and myocardial dysfunction in severe sepsis using the pressure recording analytical method (PRAM).

Methods

Patients with severe sepsis or septic shock admitted to the ICU were enrolled. We studied hemodynamic variations and cardiac performance measured with PRAM (cardiac output, stroke volume, systemic vascular resistance, stroke volume variation, pulse pressure variation, cardiac cycle efficiency (CCE), maximal rate of rise in the arterial pulse curve (dP/dt max)) for the first 24 hours. At admission, transthoracic echocardiography (TEC) was used to value the left ventricular ejection fraction (LVEF%), E/A ratio and left ventricular end-diastolic surface (LVEDS). Mortality at 28 days was measured.

Results

Eleven patients were included (six severe sepsis, five septic shock). Mortality was 9%. TEC documented systolic function preserved in all patients (LVEF > 50%); diastolic dysfunction (E/A ratio < 1) in five patients and LVEDS reduced in two patients. Hemodynamic monitoring documented a myocardial dysfunction as a reduction of CCE and dP/dt max in two patients that required inotropic support. CCE represents the ratio between the hemodynamic work and the energetic cost sustained by the heart [1].

Conclusion

PRAM seems to be a valid mini-invasive instrument in patients with sepsis for early diagnosis of myocardial dysfunction and to guide therapy. In fact, as shown in Figure 1, despite a preserved LVEF%, CCE and dP/dt max clearly detected myocardial dysfunction, because these parameters relate cardiac function with vascular condition.

Figure 1