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Left ventricular systolic dysfunction during septic shock: the role of loading conditions

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Abstract

Purpose

The clinical significance of septic myocardial dysfunction is controversial, a fact that may be explained by the influence of loading conditions. Many indices may be useful to characterize cardiac function during septic shock, but their feasibility and physiological coherence in the clinical setting are unknown.

Methods

Hemodynamic and echocardiographic data with tissue Doppler and speckle tracking were prospectively recorded on the first 3 days of human septic shock. Hypokinesia, normokinesia, and hyperkinesia were defined as a left ventricular ejection fraction (LVEF) of <45, 45–60, and >60%, respectively. Twelve hemodynamic indices exploring contractility and loading conditions were assessed and analyzed.

Results

Two hundred and ninety-seven echocardiographies were performed in 132 patients. During the first 24 h (H1–24), 48 (36.4%) patients were hyperkinetic, 55 (41.7%) were normokinetic, and 29 (22.0%) patients were hypokinetic. Thirteen patients had a secondary hypokinesia absent at H1–24 but present at H25–48 or H49–72, for an overall incidence of 42 (31.8%) during the first 3 days. Despite a limited feasibility (<50%), global LV longitudinal peak systolic strain was impaired in a majority (>70%) of the patients assessed, including all those with depressed LVEF, and declined early in patients whose LVEF secondarily deteriorated. Most contractility indices were inversely correlated with afterload indices. Hyperkinetic patients exhibited the worst reduction in afterload indices. Hospital mortality was significantly higher in patients with LV hyperkinesia than in their counterparts: 30 (62.5%) vs. 35 (41.7%), p = 0.02.

Conclusions

Speckle tracking-derived strain was reduced in the majority of patients with septic shock, revealing covert septic myocardial dysfunction, but had poor feasibility. We found an inverse correlation between most of the contractility and afterload indices. Precise evaluation of afterload is crucial for adequate interpretation of LV systolic function in this setting.

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Author notes

  1. Florence Boissier & Arnaud W. Thille

    Present address: CHU de Poitiers, Réanimation médicale, Poitiers, France

Authors and Affiliations

  1. AP-HP, Hôpitaux universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France

    Florence Boissier, Keyvan Razazi, Aurélien Seemann, Alexandre Bedet, Arnaud W. Thille, Nicolas de Prost, Christian Brun-Buisson & Armand Mekontso Dessap

  2. Université Paris Est Créteil, Faculté de Médecine de Créteil, IMRB, GRC CARMAS, 94010, Créteil, France

    Florence Boissier, Keyvan Razazi, Alexandre Bedet, Nicolas de Prost, Christian Brun-Buisson & Armand Mekontso Dessap

  3. AP-HP, Hôpitaux universitaires Henri Mondor, Service de Cardiologie, 94010, Créteil, France

    Aurélien Seemann & Pascal Lim

  4. INSERM CIC 1402 (ALIVE group) Université de Poitiers, Poitiers, France

    Florence Boissier & Arnaud W. Thille

  5. Service de Réanimation Médicale, CHU Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France

    Armand Mekontso Dessap

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  1. Florence Boissier
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  2. Keyvan Razazi
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Corresponding author

Correspondence to Armand Mekontso Dessap.

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Take-home message

Our study supports the hypothesis of a widespread alteration of LV contractility during human septic shock and suggests that knowledge of afterload, a major prognostic factor, is crucial for adequate interpretation of LV systolic function in this setting.

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Boissier, F., Razazi, K., Seemann, A. et al. Left ventricular systolic dysfunction during septic shock: the role of loading conditions. Intensive Care Med 43, 633–642 (2017). https://doi.org/10.1007/s00134-017-4698-z

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  • DOI: https://doi.org/10.1007/s00134-017-4698-z

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