Journal
EUROPEAN HEART JOURNAL
Volume 33, Issue 7, Pages 895-903Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehr351
Keywords
Sepsis; Diastolic dysfunction; Heart failure with normal ejection fraction; Mortality; Echocardiography
Categories
Funding
- International Anesthesia Research Society (IARS)
- Hadassah Hospital
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Systolic dysfunction in septic shock is well recognized and, paradoxically, predicts better outcome. In contrast, diastolic dysfunction is often ignored and its role in determining early mortality from sepsis has not been adequately investigated. A cohort of 262 intensive care unit patients with severe sepsis or septic shock underwent two echocardiography examinations early in the course of their disease. All clinical, laboratory, and survival data were prospectively collected. Ninety-five (36) patients died in the hospital. Reduced mitral annular e-wave was the strongest predictor of mortality, even after adjusting for the APACHE-II score, low urine output, low left ventricular stroke volume index, and lowest oxygen saturation, the other independent predictors of mortality (Coxs proportional hazards: Wald 21.5, 16.3, 9.91, 7.0 and 6.6, P 0.0001, 0.0001, 0.002, 0.008, and 0.010, respectively). Patients with systolic dysfunction only (left ventricular ejection fraction 50), diastolic dysfunction only (e-wave 8 cm/s), or combined systolic and diastolic dysfunction (9.1, 40.4, and 14.1 of the patients, respectively) had higher mortality than those with no diastolic or systolic dysfunction (hazard ratio 2.9, 6.0, 6.2, P 0.035, 0.0001, 0.0001, respectively) and had significantly higher serum levels of high-sensitivity troponin-T and N-terminal pro-B-type natriuretic peptide (NT-proBNP). High-sensitivity troponin-T was only minimally elevated, whereas serum levels of NT-proBNP were markedly elevated [median (inter-quartile range): 0.07 (0.020.17) ng/mL and 5762 (100115 962) pg/mL, respectively], though both predicted mortality even after adjusting for highest creatinine levels (Wald 5.8, 21.4 and 2.3, P 0.015, 0.001 and 0.13). Diastolic dysfunction is common and is a major predictor of mortality in severe sepsis and septic shock.
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