A better prognosis for septic patients with left ventricular dysfunction?

Introduction

Several studies using angiographic or echocardiographic methods have shown that in septic shock (SSh) or severe sepsis (SeS), cardiac abnormalities, which are often documented [1], seem to have a relevant prognostic significance [2, 3].

Methods

A retrospective study was conduced during 6 months (April to September 2009) in an ICU of a university tertiary hospital, identifying all patients with SSh or SeS and reviewing their echocardiographic data. All the patients with known or clinical/echocardiographic evidence of significant prior cardiac disease were excluded from this analysis.

Results

Forty-nine patients were identified with SSh or SeS from a total of 211 ICU patients (23.2%). Among these, 26 had echocardiograms done during their ICU stay (53.1%). We analyzed 19 echocardiograms from 15 patients. The remaining 11 patients were excluded, having ischemic heart disease (seven patients) and significant valvular heart disease (four patients). Within the SSh/SeS group of patients, those with echocardiograms were younger (mean age 56.3 vs 64.4) and more often women (53.3% vs 36.7%). The ICU mortality was nevertheless similar in the two groups (46.7% vs 46.9%). The primary sites of infection were the lungs and abdomen (26.7% each) or unknown (20%). The agents most frequently isolated were Gram-negative bacilli (26.7%). In 53.3% of cases there was no identified agent. Echocardiographic evaluation revealed significant changes in 26.7% of the patients, with the remaining being considered normal. Of those with significant changes, 75% (n = 3) showed impairment of left ventricular (LV) systolic function with global hypokinesia simultaneously with diastolic dysfunction. Either abnormality was not found in any other patients. The mortality rate during ICU stay was lower in the group of patients with systolic and diastolic LV dysfunction compared with those with no apparent modification of LV function (0 vs 58.3%). The right ventricle was dilated and showed high systolic pressures present in only one patient.

Conclusions

This study reinforces the concept that changes in systolic and diastolic functions are common in septic shock and severe septic patients, and that the development of these changes (as an adaptation mechanism) seems to correlate inversely with the acute mortality rate during ICU stay [2, 4].