Frequency and clinical spectrum of myocardial dysfunction in severe sepsis and septic shock

Introduction

Myocardial dysfunction is reportedly a common complication of sepsis that requires specific management. Although frequently reported in the literature, the clinical spectrum and frequency of this organ failure have not been fully appreciated. We sought to determine the frequency of myocardial dysfunction in severe sepsis and septic shock and to describe the clinical spectrum of this entity with transthoracic echocardiography.

Methods

Prospective single-center study capturing all patients admitted to the ICU with severe sepsis or septic shock from May 2007 to January 2009. All patients enrolled underwent comprehensive transthoracic echocardiography on admission. The exclusion criteria included <18 years of age, pregnancy, documented ischemic, valvular or congenital heart disease. All patients with LV systolic dysfunction defined as LVEF <50% received a repeat echocardiographic study at 5 days or upon dismissal from ICU.

Results

One hundred and six patients were enrolled, mean age was 65, and 50% were female. The mean SOFA score was 11. Central venous oxygen saturation was less than 70% in 37% of patients. Twenty-nine patients (27%) had global LV systolic dysfunction (14 = mild, nine = moderate, six = severe), 33 patients (31%) had RV dysfunction (18 = mild, nine = moderate, six = severe), 14 patients had biventricular involvement (13%) and 39 patients (37%) had diastolic filling abnormalities. Of the 29 patients with LV systolic dysfunction on initial examination, 28 received a follow-up echocardiogram and 96% of these patients (n = 27) improved in all parameters. Thirty-day mortality was 39%, 6-month mortality 52%. Myocardial dysfunction did not predict mortality.

Conclusions

These results confirm that myocardial dysfunction is frequent and broad in patients with severe sepsis and septic shock. Right ventricular involvement and diastolic abnormalities should be considered as part of the clinical spectrum of this entity. There was poor correlation with myocardial dysfunction and mortality and it was reversible regardless of presentation. We should not focus only on left ventricular ejection fraction to diagnose myocardial dysfunction in sepsis, since only a small portion of these patients had isolated LV systolic dysfunction.