Sepsis-Associated Myocardial Dysfunction: Prognosis and Rationale for the Use of Biomarkers

By analysis of other hemodynamic variables derived from PAC and transesophageal echocardiography measurements, these three groups were characterized as follows: (1) normal LVFAC, normal transmitral and pulmonary flow (ie, E/A of > 1 and S/D > 1), corresponding to normal systolic and diastolic left ventricular function; (2) normal LVFAC, abnormal pulmonary vein flow (ie, E/A of > 1 and S/D of < 1 [called pseudonormal transmitral inflow]), which has been interpreted as isolated diastolic dysfunction; and (3) decreased LVFAC, abnormal transmitral and pulmonary vein flow pattern (ie, E/A of < 1 and S/D of < 1), which might be explained by diastolic dysfunction as a consequence of systolic dysfunction. The patients in the latter group were significantly older and had a higher mortality rate than those patients in the other two groups. There was no significant difference in systemic vascular resistance or LVSWI between the groups. This study is limited by a small number of patients, but, interestingly, it revealed that patients with lower LVFAC have worse outcome, which is contradictory to the results of the study by Parker et al, and that patients with preserved LVFAC have better outcome regardless of the presence of diastolic dysfunction.
In the landmark study by Parker et al, patients were grouped according to their mortality, and patients showing left ventricular dilation and depression of LVEF had a good prognosis. Paradoxically, many studies using echocardiography, including the above-mentioned transesophageal investigation by Poelaert et al, have shown that an impaired LVEF is associated with a poor prognosis.’ This might be explained by the fact that in patients with septic shock the measurement of LVEF alone does not sufficiently characterize the underlying hemodynamic pattern, and that outcome depends on parameters other than LVEF. An analysis using PAC data has revealed that a heart rate of < 106 beats/min at the initial evaluation, and a heart rate < 95 beats/ min and a systemic vascular resistance index of > 1,529 dyne • s • cm per m2 24 h after the onset of shock predicted survival.

This entry was posted in Cardiology and tagged cardiac troponins, myocardial dysfunction, natriuretic peptides, sepsis, septic shock.