Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2015 Oct-Dec;27(4):333-9.
doi: 10.5935/0103-507X.20150057.

Prognostic value of ventricular diastolic dysfunction in patients with severe sepsis and septic shock

[Article in English, Portuguese]
Gustavo Rolando  1 , Emilio Daniel Valenzuela Espinoza  2 , Emelin Avid  2 , Sebastián Welsh  2 , Juan Del Pozo  2 , Alejandro Risso Vazquez  2 , Yanina Arzani  2 , Fabio Daniel Masevicius  2 , Arnaldo Dubin  2
Affiliations
Observational Study

Prognostic value of ventricular diastolic dysfunction in patients with severe sepsis and septic shock

[Article in English, Portuguese]
Gustavo Rolando et al. Rev Bras Ter Intensiva. 2015 Oct-Dec.

Abstract
in English, Portuguese

Objectives: To evaluate the prevalence of myocardial dysfunction and its prognostic value in patients with severe sepsis and septic shock.

Methods: Adult septic patients admitted to an intensive care unit were prospectively studied using transthoracic echocardiography within the first 48 hours after admission and thereafter on the 7th-10th days. Echocardiographic variables of biventricular function, including the E/e' ratio, were compared between survivors and non-survivors.

Results: A total of 99 echocardiograms (53 at admission and 46 between days 7 - 10) were performed on 53 patients with a mean age of 74 (SD 13) years. Systolic and diastolic dysfunction was present in 14 (26%) and 42 (83%) patients, respectively, and both types of dysfunction were present in 12 (23%) patients. The E/e' ratio, an index of diastolic dysfunction, was the best predictor of hospital mortality according to the area under the ROC curve (0.71) and was an independent predictor of outcome, as determined by multivariate analysis (OR = 1.36 [1.05 - 1.76], p = 0.02).

Conclusion: In septic patients admitted to an intensive care unit, echocardiographic systolic dysfunction is not associated with increased mortality. In contrast, diastolic dysfunction is an independent predictor of outcome.

Objetivo: Avaliar a prevalência de disfunção miocárdica e seu valor prognóstico em pacientes com sepse grave e choque séptico.

Métodos: Pacientes sépticos adultos, admitidos em uma unidade de terapia intensiva, foram estudados de forma prospectiva por meio de ecocardiografia transtorácica dentro das primeiras 48 horas após sua admissão e, então, entre o sétimo e o décimo dias. As variáveis ecográficas de função biventricular, inclusive a relação E/e', foram comparadas entre sobreviventes e não sobreviventes.

Resultados: Foi realizado um total de 99 ecocardiogramas (53 na admissão e 46 entre os dias 7 e 10) em 53 pacientes com média de idade de 74 anos (desvio padrão de 13 anos). Estava presente disfunção sistólica em 14 (26%); disfunção diastólica foi observada em 42 (83%) pacientes; e ambos os tipos de disfunção estavam presentes em 12 (23%) pacientes. A relação E/e', ou índice de disfunção diastólica, foi o melhor preditor de mortalidade hospitalar segundo a área sob a curva ROC (0,71) e se constituiu em um preditor independente do desfecho, conforme determinado pela análise multivariada (odds ratio - OR = 1,36 [1,05 - 1,76]; p = 0,02).

Conclusão: Em pacientes sépticos admitidos em uma unidade de terapia intensiva, a disfunção sistólica determinada ecograficamente não se associa com aumento da mortalidade. Em contraste, a disfunção diastólica foi um preditor independente do desfecho.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: None.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Antonucci E, Fiaccadori E, Donadello K, Taccone FS, Franchi F, Scolletta S. Myocardial depression in sepsis: from pathogenesis to clinical manifestations and treatment. J Crit Care. 2014;29(4):500–511. Review. - PubMed
    1. Vieillard-Baron A. Septic cardiomyopathy. Ann Intensive Care. 2011;1(1):6–6. - PMC - PubMed
    1. Vieillard-Baron A, Caille V, Charron C, Belliard G, Page B, Jardin F. Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit Care Med. 2008;36(6):1701–1706. - PubMed
    1. Verdecchia P, Angeli F, Gattobigio R, Sardone M, Porcellati C. Asymptomatic left ventricular systolic dysfunction in essential hypertension: prevalence, determinants and prognostic value. Hypertension. 2005;45(3):412–418. - PubMed
    1. Marchioli R, Avanzini F, Barzi F, Chieffo C, Di Castelnuovo A, Franzosi MG, Geraci E, Maggioni AP, Marfisi RM, Mininni N, Nicolosi GL, Santini M, Schweiger C, Tavazzi L, Tognoni G, Valagussa F, GISSI-Prevenzione Investigators Assessment of absolute risk of death after myocardial infarction by use of multiple-risk-factor assessment equations. GISSI-Prevenzione mortality risk chart. Eur Heart J. 2001;22(22):2085–2103. - PubMed

Publication types

MeSH terms