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Clinical Research in Cardiology

, Volume 100, Issue 8, pp 661–668 | Cite as

Septic cardiomyopathy: hemodynamic quantification, occurrence, and prognostic implications

  • Karl Werdan
  • Anja Oelke
  • Stefan Hettwer
  • Sebastian Nuding
  • Sebastian Bubel
  • Robert Hoke
  • Martin Ruß
  • Christine Lautenschläger
  • Ursula Mueller-Werdan
  • Henning EbeltEmail author
Original Paper

Abstract

Introduction

In sepsis, severe reduction of afterload may often mask cardiac impairment. By establishing the parameter “afterload-related cardiac performance (ACP)” we wanted to determine the extent, frequency, and prognostic relevance of septic cardiomyopathy.

Methods

Over a 12 months period, all patients of our medical intensive care ward were included into the study when they were classified as having “septic MODS” (sepsis score ≥12 as long as APACHE II score was ≥20). Hemodynamic assessments were performed using a pulmonary artery catheter.

Results

A total of 524 patients were screened, and from these 39 had septic MODS. In survivors, APACHE II score values declined from day 0 (day of diagnosis, 27.6 ± 8.0) to day 4 (17.8 ± 8.0), while in non-survivors, score values remained high (day 0: 31.8 ± 5.7; day 4: 33.2 ± 6.7; p < 0.001). Hemodynamic measurements showed an inverse correlation of cardiac output (COmeasured) and SVR which can be described as CO = β 0 × SVR β1. The upper limit of 80% tolerance range of CO was defined as the “normal” CO values (COnormal). The parameter “afterload-related cardiac performance (ACP)” was calculated as ACP (%) = COmeasured/COnormal × 100. It turned out that ACP shows a stronger correlation with APACHE II- and sepsis-score than CO, cardiac index (CI), cardiac power (CPO), or cardiac power index (CPI). Furthermore, ACP correlated with sepsis-induced myocardial damage as indicated by elevations of troponin I and significantly differed between surviving (86.9 ± 1.6%) and non-surviving patients (69.2 ± 1.4%; p < 0.0001). While 75% of the surviving patients showed an ACP >60%, 38% of the non-survivors had a moderate (ACP 40–60%) and 25% a severe impairment of cardiac function (ACP < 40%).

Conclusion

By using the parameter “afterload-related cardiac performance, ACP”, the impairment of cardiac function can be reliably quantified showing that septic cardiomyopathy occurs frequently and is of prognostic relevance in patients with septic MODS.

Keywords

Sepsis Septic shock Septic cardiomyopathy Cardiac output Cardiac power Afterload-related cardiac performance 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Karl Werdan
    • 1
  • Anja Oelke
    • 1
  • Stefan Hettwer
    • 1
  • Sebastian Nuding
    • 1
  • Sebastian Bubel
    • 1
  • Robert Hoke
    • 1
  • Martin Ruß
    • 1
  • Christine Lautenschläger
    • 2
  • Ursula Mueller-Werdan
    • 1
  • Henning Ebelt
    • 1
    Email author
  1. 1.Department of Medicine IIIUniversity of Halle (Saale)HalleGermany
  2. 2.Institute of Medical Epidemiology, Biometrics, and StatisticsUniversity of Halle (Saale)HalleGermany

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