Left ventricular diastolic function in sepsis

Abstract

Although systolic dysfunction of the left ventricle has been characterized in septic shock (SS) and sepsis without shock (SWS), diastolic abnormalities are less well characterized. Diastolic filling was determined using pulsed Doppler transmitral spectral tracings in 13 patients with SS, ten patients with SWS, and 33 normal controls. Diastolic filling variables and heart rate were similar in patients with SS and SWS. The SS and SWS patients had an abnormal pattern of diastolic filling compared with controls and were characterized by an increase in peak atrial velocity (70 +/- 20 cm/sec SS, 84 +/- 18 cm/sec SWS vs. 56 +/- 11 cm/sec controls, p less than .05), decreased peak rapid filling velocity/peak atrial filling velocity (1.1 +/- 0.3, SS, 1.1 +/- 0.2 SWS vs. 1.5 +/- 0.4 controls, p less than .05), increased atrial filling fraction (39 +/- 11 SS, 42 +/- 6 SWS vs. 30 +/- 10 controls, p less than .05) and prolongation of atrial filling period as a function of the diastolic filling period (0.48 +/- 0.10 SS, 0.43 +/- 0.10 SWS vs. 0.30 +/- 0.07 controls, p less than .05). Heart rate was higher in SS and SWS compared with controls (116 +/- 15 beat/min SS, 110 +/- 26 beat/min SWS vs. 73 +/- 12 beat/min controls, p less than .05). In patients with SS and SWS, there is increased reliance on atrial systolic contribution to diastolic filling. We conclude that diastolic dysfunction occurs with systemic infections.