Diastolic dysfunction and mortality in early severe sepsis and septic shock: a prospective, observational echocardiography study

Background Patients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of diastolic dysfunction assessed by transthoracic echocardiography (TTE) predicts 28-day mortality. Methods In this prospective, observational study c...

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Published inCritical ultrasound journal Vol. 4; no. 1; p. 8
Main Authors Brown, Samuel M, Pittman, Joel E, Hirshberg, Eliotte L, Jones, Jason P, Lanspa, Michael J, Kuttler, Kathryn G, Litwin, Sheldon E, Grissom, Colin K
Format Journal Article
LanguageEnglish
Published Milan Springer Milan 04.05.2012
Springer Nature B.V
BioMed Central Ltd
Springer
Subjects
Critical Care Medicine
Diagnostic Radiology
Emergency Medicine
Imaging
Intensive
Interventional Radiology
Medicine
Medicine & Public Health
Original
Original Article
Radiology
Ultrasound
Shock
Sepsis
Diastolic dysfunction
echocardiography
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Abstract Background Patients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of diastolic dysfunction assessed by transthoracic echocardiography (TTE) predicts 28-day mortality. Methods In this prospective, observational study conducted in two intensive care units at a tertiary care hospital, 78 patients (age 53.2 ± 17.1 years; 51% females; mean APACHE II score 23.3 ± 7.4) with severe sepsis or septic shock underwent TTE within 6 h of ICU admission, after 18 to 32 h, and after resolution of shock. Left ventricular (LV) diastolic dysfunction was defined according to modified American Society of Echocardiography 2009 guidelines using E, A, and e’ velocities; E/A and E/e’; and E deceleration time. Systolic dysfunction was defined as an ejection fraction < 45%. Results Twenty-seven patients (36.5%) had diastolic dysfunction on initial echocardiogram, while 47 patients (61.8%) had diastolic dysfunction on at least one echocardiogram. Total mortality was 16.5%. The highest mortality (37.5%) was observed among patients with grade I diastolic dysfunction, an effect that persisted after controlling for age and APACHE II score. At time of initial TTE, central venous pressure (CVP) (11+/- 5 mmHg) did not differ among grades I-III, although patients with grade I received less intravenous fluid. Conclusions LV diastolic dysfunction is common in septic patients. Grade I diastolic dysfunction, but not grades II and III, was associated with increased mortality. This finding may reflect inadequate fluid resuscitation in early sepsis despite an elevated CVP, suggesting a possible role for TTE in sepsis resuscitation.
AbstractList Background Patients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of diastolic dysfunction assessed by transthoracic echocardiography (TTE) predicts 28-day mortality. Methods In this prospective, observational study conducted in two intensive care units at a tertiary care hospital, 78 patients (age 53.2±17.1years; 51% females; mean APACHE II score 23.3±7.4) with severe sepsis or septic shock underwent TTE within 6h of ICU admission, after 18 to 32h, and after resolution of shock. Left ventricular (LV) diastolic dysfunction was defined according to modified American Society of Echocardiography 2009 guidelines using E, A, and e' velocities; E/A and E/e'; and E deceleration time. Systolic dysfunction was defined as an ejection fraction<45%. Results Twenty-seven patients (36.5%) had diastolic dysfunction on initial echocardiogram, while 47 patients (61.8%) had diastolic dysfunction on at least one echocardiogram. Total mortality was 16.5%. The highest mortality (37.5%) was observed among patients with grade I diastolic dysfunction, an effect that persisted after controlling for age and APACHE II score. At time of initial TTE, central venous pressure (CVP) (11+/- 5mmHg) did not differ among grades I-III, although patients with grade I received less intravenous fluid. Conclusions LV diastolic dysfunction is common in septic patients. Grade I diastolic dysfunction, but not grades II and III, was associated with increased mortality. This finding may reflect inadequate fluid resuscitation in early sepsis despite an elevated CVP, suggesting a possible role for TTE in sepsis resuscitation.
Background Patients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of diastolic dysfunction assessed by transthoracic echocardiography (TTE) predicts 28-day mortality. Methods In this prospective, observational study conducted in two intensive care units at a tertiary care hospital, 78 patients (age 53.2 ± 17.1 years; 51% females; mean APACHE II score 23.3 ± 7.4) with severe sepsis or septic shock underwent TTE within 6 h of ICU admission, after 18 to 32 h, and after resolution of shock. Left ventricular (LV) diastolic dysfunction was defined according to modified American Society of Echocardiography 2009 guidelines using E, A, and e’ velocities; E/A and E/e’; and E deceleration time. Systolic dysfunction was defined as an ejection fraction < 45%. Results Twenty-seven patients (36.5%) had diastolic dysfunction on initial echocardiogram, while 47 patients (61.8%) had diastolic dysfunction on at least one echocardiogram. Total mortality was 16.5%. The highest mortality (37.5%) was observed among patients with grade I diastolic dysfunction, an effect that persisted after controlling for age and APACHE II score. At time of initial TTE, central venous pressure (CVP) (11+/- 5 mmHg) did not differ among grades I-III, although patients with grade I received less intravenous fluid. Conclusions LV diastolic dysfunction is common in septic patients. Grade I diastolic dysfunction, but not grades II and III, was associated with increased mortality. This finding may reflect inadequate fluid resuscitation in early sepsis despite an elevated CVP, suggesting a possible role for TTE in sepsis resuscitation.
Patients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of diastolic dysfunction assessed by transthoracic echocardiography (TTE) predicts 28-day mortality. In this prospective, observational study conducted in two intensive care units at a tertiary care hospital, 78 patients (age 53.2 ± 17.1 years; 51% females; mean APACHE II score 23.3 ± 7.4) with severe sepsis or septic shock underwent TTE within 6 h of ICU admission, after 18 to 32 h, and after resolution of shock. Left ventricular (LV) diastolic dysfunction was defined according to modified American Society of Echocardiography 2009 guidelines using E, A, and e' velocities; E/A and E/e'; and E deceleration time. Systolic dysfunction was defined as an ejection fraction < 45%. Twenty-seven patients (36.5%) had diastolic dysfunction on initial echocardiogram, while 47 patients (61.8%) had diastolic dysfunction on at least one echocardiogram. Total mortality was 16.5%. The highest mortality (37.5%) was observed among patients with grade I diastolic dysfunction, an effect that persisted after controlling for age and APACHE II score. At time of initial TTE, central venous pressure (CVP) (11+/- 5 mmHg) did not differ among grades I-III, although patients with grade I received less intravenous fluid. LV diastolic dysfunction is common in septic patients. Grade I diastolic dysfunction, but not grades II and III, was associated with increased mortality. This finding may reflect inadequate fluid resuscitation in early sepsis despite an elevated CVP, suggesting a possible role for TTE in sepsis resuscitation.
UNLABELLED BACKGROUNDPatients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of diastolic dysfunction assessed by transthoracic echocardiography (TTE) predicts 28-day mortality. METHODSIn this prospective, observational study conducted in two intensive care units at a tertiary care hospital, 78 patients (age 53.2 ± 17.1 years; 51% females; mean APACHE II score 23.3 ± 7.4) with severe sepsis or septic shock underwent TTE within 6 h of ICU admission, after 18 to 32 h, and after resolution of shock. Left ventricular (LV) diastolic dysfunction was defined according to modified American Society of Echocardiography 2009 guidelines using E, A, and e' velocities; E/A and E/e'; and E deceleration time. Systolic dysfunction was defined as an ejection fraction < 45%. RESULTSTwenty-seven patients (36.5%) had diastolic dysfunction on initial echocardiogram, while 47 patients (61.8%) had diastolic dysfunction on at least one echocardiogram. Total mortality was 16.5%. The highest mortality (37.5%) was observed among patients with grade I diastolic dysfunction, an effect that persisted after controlling for age and APACHE II score. At time of initial TTE, central venous pressure (CVP) (11+/- 5 mmHg) did not differ among grades I-III, although patients with grade I received less intravenous fluid. CONCLUSIONSLV diastolic dysfunction is common in septic patients. Grade I diastolic dysfunction, but not grades II and III, was associated with increased mortality. This finding may reflect inadequate fluid resuscitation in early sepsis despite an elevated CVP, suggesting a possible role for TTE in sepsis resuscitation.
BACKGROUND: Patients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of diastolic dysfunction assessed by transthoracic echocardiography (TTE) predicts 28-day mortality. METHODS: In this prospective, observational study conducted in two intensive care units at a tertiary care hospital, 78 patients (age 53.2 ± 17.1 years; 51% females; mean APACHE II score 23.3 ± 7.4) with severe sepsis or septic shock underwent TTE within 6 h of ICU admission, after 18 to 32 h, and after resolution of shock. Left ventricular (LV) diastolic dysfunction was defined according to modified American Society of Echocardiography 2009 guidelines using E, A, and e' velocities; E/A and E/e'; and E deceleration time. Systolic dysfunction was defined as an ejection fraction < 45%. RESULTS: Twenty-seven patients (36.5%) had diastolic dysfunction on initial echocardiogram, while 47 patients (61.8%) had diastolic dysfunction on at least one echocardiogram. Total mortality was 16.5%. The highest mortality (37.5%) was observed among patients with grade I diastolic dysfunction, an effect that persisted after controlling for age and APACHE II score. At time of initial TTE, central venous pressure (CVP) (11+/- 5 mmHg) did not differ among grades I-III, although patients with grade I received less intravenous fluid. CONCLUSIONS: LV diastolic dysfunction is common in septic patients. Grade I diastolic dysfunction, but not grades II and III, was associated with increased mortality. This finding may reflect inadequate fluid resuscitation in early sepsis despite an elevated CVP, suggesting a possible role for TTE in sepsis resuscitation.
ArticleNumber 8
Author Grissom, Colin K
Lanspa, Michael J
Litwin, Sheldon E
Kuttler, Kathryn G
Pittman, Joel E
Hirshberg, Eliotte L
Brown, Samuel M
Jones, Jason P
AuthorAffiliation 4 Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, 84108, USA
3 Critical Care Echocardiography Service, Intermountain Medical Center, Murray, UT, 84107, USA
5 Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, 91101, USA
1 Division of Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
2 Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT, 84107, USA
7 Division of Cardiology, Georgia Health Sciences Health System, Augusta, GA, 30912, USA
6 Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, UT, 84107, USA
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– name: 6 Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, UT, 84107, USA
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  fullname: Hirshberg, Eliotte L
  organization: Division of Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Critical Care Echocardiography Service, Intermountain Medical Center, Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine
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  surname: Litwin
  fullname: Litwin, Sheldon E
  organization: Division of Cardiology, Georgia Health Sciences Health System
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  givenname: Colin K
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  fullname: Grissom, Colin K
  organization: Division of Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Critical Care Echocardiography Service, Intermountain Medical Center
BackLink https://www.ncbi.nlm.nih.gov/pubmed/22870900$$D View this record in MEDLINE/PubMed
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Issue 1
Keywords Shock
Sepsis
Diastolic dysfunction
echocardiography
Language English
License This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Snippet Background Patients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of...
Patients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of diastolic...
Background Patients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of...
UNLABELLED BACKGROUNDPatients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity...
BACKGROUND: Patients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of...
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StartPage 8
SubjectTerms Critical Care Medicine
Diagnostic Radiology
Emergency Medicine
Imaging
Intensive
Interventional Radiology
Medicine
Medicine & Public Health
Original
Original Article
Radiology
Ultrasound
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Title Diastolic dysfunction and mortality in early severe sepsis and septic shock: a prospective, observational echocardiography study
URI https://link.springer.com/article/10.1186/2036-7902-4-8
https://www.ncbi.nlm.nih.gov/pubmed/22870900
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https://search.proquest.com/docview/1222231148
http://dx.doi.org/10.1186/2036-7902-4-8
https://pubmed.ncbi.nlm.nih.gov/PMC3512479
Volume 4
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