Abstract
Background
Myocardial dysfunction may contribute to the haemodynamic instability which accompanies sepsis, and may result in circulatory failure. There is no association between systolic dysfunction (SD) and mortality in septic patients and there is conflicting evidence regarding the effects of diastolic dysfunction (DD) on mortality in septic patients.
Methods
We conducted a systematic review and meta-analysis to investigate DD and mortality in septic patients. We included studies conducted in this patient population which investigated the association between DD reported according to tissue Doppler imaging (TDI) criteria and mortality, using the longest reported follow-up. As a secondary endpoint, we evaluated the association between SD and mortality according to the results reported by the retrieved studies.
Results
We included seven studies in our meta-analysis with 636 septic patients, 48 % of them were found to have DD. We found a significant association between DD and mortality (RR 1.82, 95 % CI 1.12–2.97, p = 0.02). This finding remained valid in a further analysis which including an older study reporting DD without TDI criteria. Five studies reported data on SD for a total of 581 patients, 29.6 % of them with SD. No association was found between SD and mortality (RR 0.93, 95 % CI 0.62–1.39, p = 0.73). Looking at subgroups, there was a trend towards higher mortality comparing isolated DD or combined SD–DD vs normal heart function (p = 0.10 and p = 0.05, respectively).
Conclusions
Diastolic dysfunction is common in septic patients and it is associated with mortality. Systolic dysfunction is less common and is not associated with mortality in this group of patients.
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References
Angus DC, van der Poll T (2013) Severe sepsis and septic shock. N Engl J Med 369:840–851
Antonelli M, Bonten M, Chastre J, Citerio G, Conti G, Curtis JR, De Backer D, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Rocco P, Timsit JF, Wernerman J, Zhang H (2012) Year in review in Intensive Care Medicine 2011. II. Cardiovascular, infections, pneumonia and sepsis, critical care organization and outcome, education, ultrasonography, metabolism and coagulation. Intensive Care Med 38:345–358
Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R (2014) Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 311:1308–1316. doi:10.1001/jama.2014.2637
Krishnagopalan S, Kumar A, Parrillo JE, Kumar A (2002) Myocardial dysfunction in the patient with sepsis. Curr Opin Crit Care 8:376–388
Vieillard-Baron A, Cecconi M (2014) Understanding cardiac failure in sepsis. Intensive Care Med 40:1560–1563
Hunter JD, Doddi M (2010) Sepsis and the heart. Br J Anaesth 104:3–11
Bouhemad B, Nicolas-Robin A, Arbelot C, Arthaud M, Feger F, Rouby JJ (2008) Isolated and reversible impairment of ventricular relaxation in patients with septic shock. Crit Care Med 36:766–774
Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ (2003) Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 289:194–202
Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355:251–259
Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC, Committee ASA, Investigators (2006) Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database. J Am Coll Cardiol 47:76–84
Gandhi SK, Powers JC, Nomeir AM, Fowle K, Kitzman DW, Rankin KM, Little WC (2001) The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med 344:17–22
Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S, Avidan A, Beeri R, Weissman C, Jaffe AS, Sprung CL (2012) Diastolic dysfunction and mortality in severe sepsis and septic shock. Eur Heart J 33:895–903
Pulido JN, Afessa B, Masaki M, Yuasa T, Gillespie S, Herasevich V, Brown DR, Oh JK (2012) Clinical spectrum, frequency, and significance of myocardial dysfunction in severe sepsis and septic shock. Mayo Clin Proc 87:620–628
Natanson C, Fink MP, Ballantyne HK, MacVittie TJ, Conklin JJ, Parrillo JE (1986) Gram-negative bacteremia produces both severe systolic and diastolic cardiac dysfunction in a canine model that simulates human septic shock. J Clin Investig 78:259–270
Parker JL, Keller RS, Behm LL, Adams HR (1990) Left ventricular dysfunction in early E. coli endotoxemia: effects of naloxone. Am J Physiol 259:H504–H511
Huang SJ, Nalos M, McLean AS (2013) Is early ventricular dysfunction or dilatation associated with lower mortality rate in adult severe sepsis and septic shock? A meta-analysis. Crit Care 17:R96
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–e34
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R, Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228
Ho CY, Solomon SD (2006) A clinician’s guide to tissue Doppler imaging. Circulation 113:e396–e398
Higgins J, Thompson S, Deeks J, Altman D (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560
Bax L, Yu LM, Ikeda N, Tsuruta H, Moons KG (2006) Development and validation of MIX: comprehensive free software for meta-analysis of causal research data. BMC Med Res Methodol 6:50
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634
Etchecopar-Chevreuil C, Francois B, Clavel M, Pichon N, Gastinne H, Vignon P (2008) Cardiac morphological and functional changes during early septic shock: a transesophageal echocardiographic study. Intensive Care Med 34:250–256
Landesberg G, Jaffe AS, Gilon D, Levin PD, Goodman S, Abu-Baih A, Beeri R, Weissman C, Sprung CL, Landesberg A (2014) Troponin elevation in severe sepsis and septic shock: the role of left ventricular diastolic dysfunction and right ventricular dilatation. Crit Care Med 42:790–800
Mokart D, Sannini A, Brun JP, Faucher M, Blaise D, Blache JL, Faucher C (2007) N-terminal pro-brain natriuretic peptide as an early prognostic factor in cancer patients developing septic shock. Crit Care 11:R37
Mourad M, Chow-Chine L, Faucher M, Sannini A, Brun JP, de Guibert JM, Fouche L, Lambert J, Blache JL, Mokart D (2014) Early diastolic dysfunction is associated with intensive care unit mortality in cancer patients presenting with septic shock. Br J Anaesth 112:102–109
Sturgess DJ, Marwick TH, Joyce C, Jenkins C, Jones M, Masci P, Stewart D, Venkatesh B (2010) Prediction of hospital outcome in septic shock: a prospective comparison of tissue Doppler and cardiac biomarkers. Crit Care 14:R44
Poelaert J, Declerck C, Vogelaers D, Colardyn F, Visser CA (1997) Left ventricular systolic and diastolic function in septic shock. Intensive Care Med 23:553–560
Munt B, Jue J, Gin K, Fenwick J, Tweeddale M (1998) Diastolic filling in human severe sepsis: an echocardiographic study. Crit Care Med 26:1829–1833
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelisa A (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 10:165–193
Raj S, Killinger JS, Gonzalez JA, Lopez L (2014) Myocardial dysfunction in pediatric septic shock. J Pediatrics 164(72–77):e72
Mahjoub Y, Benoit-Fallet H, Airapetian N, Lorne E, Levrard M, Seydi AA, Amennouche N, Slama M, Dupont H (2012) Improvement of left ventricular relaxation as assessed by tissue Doppler imaging in fluid-responsive critically ill septic patients. Intensive Care Med 38:1461–1470
Mousavi N, Czarnecki A, Ahmadie R, Tielan F, Kumar K, Lytwyn M, Kumar A, Jassal DS (2010) The utility of tissue Doppler imaging for the noninvasive determination of left ventricular filling pressures in patients with septic shock. J Intensive Care Med 25:163–167
Nishimura RA, Tajik AJ (1997) Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta Stone. J Am Coll Cardiol 30:8–18
Caille V, Amiel JB, Charron C, Belliard G, Vieillard-Baron A, Vignon P (2010) Echocardiography: a help in the weaning process. Crit Care 14:R120
Papanikolaou J, Makris D, Saranteas T, Karakitsos D, Zintzaras E, Karabinis A, Kostopanagiotou G, Zakynthinos E (2011) New insights into weaning from mechanical ventilation: left ventricular diastolic dysfunction is a key player. Intensive Care Med 37:1976–1985
Bernard F, Denault A, Babin D, Goyer C, Couture P, Couturier A, Buithieu J (2001) Diastolic dysfunction is predictive of difficult weaning from cardiopulmonary bypass. Anesth Analg 92:291–298
Licker M, Cikirikcioglu M, Inan C, Cartier V, Kalangos A, Theologou T, Cassina T, Diaper J (2010) Preoperative diastolic function predicts the onset of left ventricular dysfunction following aortic valve replacement in high-risk patients with aortic stenosis. Crit Care 14:R101
Matyal R, Hess PE, Subramaniam B, Mitchell J, Panzica PJ, Pomposelli F, Mahmood F (2009) Perioperative diastolic dysfunction during vascular surgery and its association with postoperative outcome. J Vasc Surg 50:70–76
Flu WJ, van Kuijk JP, Hoeks SE, Kuiper R, Schouten O, Goei D, Elhendy A, Verhagen HJ, Thomson IR, Bax JJ, Fleisher LA, Poldermans D (2010) Prognostic implications of asymptomatic left ventricular dysfunction in patients undergoing vascular surgery. Anesthesiology 112:1316–1324
Janssen PM, Periasamy M (2007) Determinants of frequency-dependent contraction and relaxation of mammalian myocardium. J Mol Cell Cardiol 43:523–531
Joulin O, Marechaux S, Hassoun S, Montaigne D, Lancel S, Neviere R (2009) Cardiac force-frequency relationship and frequency-dependent acceleration of relaxation are impaired in LPS-treated rats. Crit Care 13:R14
Makrygiannis SS, Margariti A, Rizikou D, Lampakis M, Vangelis S, Ampartzidou OS, Katsifa K, Tselioti P, Foussas SG, Prekates AA (2014) Incidence and predictors of new-onset atrial fibrillation in noncardiac intensive care unit patients. J Crit Care 29(697):e691–e695. doi:10.1016/j.jcrc.2014.1003.1029
Morelli A, Ertmer C, Westphal M, Rehberg S, Kampmeier T, Ligges S, Orecchioni A, D’Egidio A, D’Ippoliti F, Raffone C, Venditti M, Guarracino F, Girardis M, Tritapepe L, Pietropaoli P, Mebazaa A, Singer M (2013) Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: a randomized clinical trial. JAMA 310:1683–1691. doi:10.1001/jama.2013.278477
Sanfilippo F, Santonocito C, Maybauer MO (2014) Short-acting beta-blocker administration in patients with septic shock. JAMA 311:736
Jorgensen K, Bech-Hanssen O, Houltz E, Ricksten SE (2008) Effects of levosimendan on left ventricular relaxation and early filling at maintained preload and afterload conditions after aortic valve replacement for aortic stenosis. Circulation 117:1075–1081
Bergstrom A, Andersson B, Edner M, Nylander E, Persson H, Dahlstrom U (2004) Effect of carvedilol on diastolic function in patients with diastolic heart failure and preserved systolic function. Results of the Swedish Doppler—echocardiographic study (SWEDIC). Eur J Heart Fail 6:453–461
Ouellette DR, Shah SZ (2014) Comparison of outcomes from sepsis between patients with and without pre-existing left ventricular dysfunction: a case-control analysis. Crit Care 18:R79
Soble JS (1998) Doppler “diastology”: a new twist to the study of sepsis. Crit Care Med 26:1777–1778
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Sanfilippo, F., Corredor, C., Fletcher, N. et al. Diastolic dysfunction and mortality in septic patients: a systematic review and meta-analysis. Intensive Care Med 41, 1004–1013 (2015). https://doi.org/10.1007/s00134-015-3748-7
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DOI: https://doi.org/10.1007/s00134-015-3748-7