Clinical spectrum, frequency, and significance of myocardial dysfunction in severe sepsis and septic shock

Juan N. Pulido, Bekele Afessa, Mitsuru Masaki, Toshinori Yuasa, Shane Gillespie, Vitaly D Herasevich, Daniel R. Brown, Jae Kuen Oh

Research output: Contribution to journalArticle

128 Citations (Scopus)

Abstract

Objective: To determine the frequency and spectrum of myocardial dysfunction in patients with severe sepsis and septic shock using transthoracic echocardiography and to evaluate the impact of the myocardial dysfunction types on mortality. Patients and Methods: A prospective study of 106 patients with severe sepsis or septic shock was conducted from August 1, 2007, to January 31, 2009. All patients underwent transthoracic echocardiography within 24 hours of admission to the intensive care unit. Myocardial dysfunction was classified as left ventricular (LV) diastolic, LV systolic, and right ventricular (RV) dysfunction. Frequency of myocardial dysfunction was calculated, and demographic, hemodynamic, and physiologic variables and mortality were compared between the myocardial dysfunction types and patients without cardiac dysfunction. Results: The frequency of myocardial dysfunction in patients with severe sepsis or septic shock was 64% (n±68). Left ventricular diastolic dysfunction was present in 39 patients (37%), LV systolic dysfunction in 29 (27%), and RV dysfunction in 33 (31%). There was significant overlap. The 30-day and 1-year mortality rates were 36% and 57%, respectively. There was no difference in mortality between patients with normal myocardial function and those with left, right, or any ventricular dysfunction. Conclusion: Myocardial dysfunction is frequent in patients with severe sepsis or septic shock and has a wide spectrum including LV diastolic, LV systolic, and RV dysfunction types. Although evaluation for the presence and type of myocardial dysfunction is important for tailoring specific therapy, its presence in patients with severe sepsis and septic shock was not associated with increased 30-day or 1-year mortality.

Original languageEnglish (US)
Pages (from-to)620-628
Number of pages9
JournalMayo Clinic Proceedings
Volume87
Issue number7
DOIs
StatePublished - Jul 2012

Fingerprint

Septic Shock
Sepsis
Right Ventricular Dysfunction
Mortality
Left Ventricular Dysfunction
Echocardiography
Ventricular Dysfunction
Intensive Care Units
Hemodynamics
Demography
Prospective Studies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Clinical spectrum, frequency, and significance of myocardial dysfunction in severe sepsis and septic shock. / Pulido, Juan N.; Afessa, Bekele; Masaki, Mitsuru; Yuasa, Toshinori; Gillespie, Shane; Herasevich, Vitaly D; Brown, Daniel R.; Oh, Jae Kuen.

In: Mayo Clinic Proceedings, Vol. 87, No. 7, 07.2012, p. 620-628.

Research output: Contribution to journalArticle

Pulido, Juan N. ; Afessa, Bekele ; Masaki, Mitsuru ; Yuasa, Toshinori ; Gillespie, Shane ; Herasevich, Vitaly D ; Brown, Daniel R. ; Oh, Jae Kuen. / Clinical spectrum, frequency, and significance of myocardial dysfunction in severe sepsis and septic shock. In: Mayo Clinic Proceedings. 2012 ; Vol. 87, No. 7. pp. 620-628.
@article{5488cbe67ef44bd9a99d2e1094411d30,
title = "Clinical spectrum, frequency, and significance of myocardial dysfunction in severe sepsis and septic shock",
abstract = "Objective: To determine the frequency and spectrum of myocardial dysfunction in patients with severe sepsis and septic shock using transthoracic echocardiography and to evaluate the impact of the myocardial dysfunction types on mortality. Patients and Methods: A prospective study of 106 patients with severe sepsis or septic shock was conducted from August 1, 2007, to January 31, 2009. All patients underwent transthoracic echocardiography within 24 hours of admission to the intensive care unit. Myocardial dysfunction was classified as left ventricular (LV) diastolic, LV systolic, and right ventricular (RV) dysfunction. Frequency of myocardial dysfunction was calculated, and demographic, hemodynamic, and physiologic variables and mortality were compared between the myocardial dysfunction types and patients without cardiac dysfunction. Results: The frequency of myocardial dysfunction in patients with severe sepsis or septic shock was 64{\%} (n±68). Left ventricular diastolic dysfunction was present in 39 patients (37{\%}), LV systolic dysfunction in 29 (27{\%}), and RV dysfunction in 33 (31{\%}). There was significant overlap. The 30-day and 1-year mortality rates were 36{\%} and 57{\%}, respectively. There was no difference in mortality between patients with normal myocardial function and those with left, right, or any ventricular dysfunction. Conclusion: Myocardial dysfunction is frequent in patients with severe sepsis or septic shock and has a wide spectrum including LV diastolic, LV systolic, and RV dysfunction types. Although evaluation for the presence and type of myocardial dysfunction is important for tailoring specific therapy, its presence in patients with severe sepsis and septic shock was not associated with increased 30-day or 1-year mortality.",
author = "Pulido, {Juan N.} and Bekele Afessa and Mitsuru Masaki and Toshinori Yuasa and Shane Gillespie and Herasevich, {Vitaly D} and Brown, {Daniel R.} and Oh, {Jae Kuen}",
year = "2012",
month = "7",
doi = "10.1016/j.mayocp.2012.01.018",
language = "English (US)",
volume = "87",
pages = "620--628",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",
number = "7",

}

TY - JOUR

T1 - Clinical spectrum, frequency, and significance of myocardial dysfunction in severe sepsis and septic shock

AU - Pulido, Juan N.

AU - Afessa, Bekele

AU - Masaki, Mitsuru

AU - Yuasa, Toshinori

AU - Gillespie, Shane

AU - Herasevich, Vitaly D

AU - Brown, Daniel R.

AU - Oh, Jae Kuen

PY - 2012/7

Y1 - 2012/7

N2 - Objective: To determine the frequency and spectrum of myocardial dysfunction in patients with severe sepsis and septic shock using transthoracic echocardiography and to evaluate the impact of the myocardial dysfunction types on mortality. Patients and Methods: A prospective study of 106 patients with severe sepsis or septic shock was conducted from August 1, 2007, to January 31, 2009. All patients underwent transthoracic echocardiography within 24 hours of admission to the intensive care unit. Myocardial dysfunction was classified as left ventricular (LV) diastolic, LV systolic, and right ventricular (RV) dysfunction. Frequency of myocardial dysfunction was calculated, and demographic, hemodynamic, and physiologic variables and mortality were compared between the myocardial dysfunction types and patients without cardiac dysfunction. Results: The frequency of myocardial dysfunction in patients with severe sepsis or septic shock was 64% (n±68). Left ventricular diastolic dysfunction was present in 39 patients (37%), LV systolic dysfunction in 29 (27%), and RV dysfunction in 33 (31%). There was significant overlap. The 30-day and 1-year mortality rates were 36% and 57%, respectively. There was no difference in mortality between patients with normal myocardial function and those with left, right, or any ventricular dysfunction. Conclusion: Myocardial dysfunction is frequent in patients with severe sepsis or septic shock and has a wide spectrum including LV diastolic, LV systolic, and RV dysfunction types. Although evaluation for the presence and type of myocardial dysfunction is important for tailoring specific therapy, its presence in patients with severe sepsis and septic shock was not associated with increased 30-day or 1-year mortality.

AB - Objective: To determine the frequency and spectrum of myocardial dysfunction in patients with severe sepsis and septic shock using transthoracic echocardiography and to evaluate the impact of the myocardial dysfunction types on mortality. Patients and Methods: A prospective study of 106 patients with severe sepsis or septic shock was conducted from August 1, 2007, to January 31, 2009. All patients underwent transthoracic echocardiography within 24 hours of admission to the intensive care unit. Myocardial dysfunction was classified as left ventricular (LV) diastolic, LV systolic, and right ventricular (RV) dysfunction. Frequency of myocardial dysfunction was calculated, and demographic, hemodynamic, and physiologic variables and mortality were compared between the myocardial dysfunction types and patients without cardiac dysfunction. Results: The frequency of myocardial dysfunction in patients with severe sepsis or septic shock was 64% (n±68). Left ventricular diastolic dysfunction was present in 39 patients (37%), LV systolic dysfunction in 29 (27%), and RV dysfunction in 33 (31%). There was significant overlap. The 30-day and 1-year mortality rates were 36% and 57%, respectively. There was no difference in mortality between patients with normal myocardial function and those with left, right, or any ventricular dysfunction. Conclusion: Myocardial dysfunction is frequent in patients with severe sepsis or septic shock and has a wide spectrum including LV diastolic, LV systolic, and RV dysfunction types. Although evaluation for the presence and type of myocardial dysfunction is important for tailoring specific therapy, its presence in patients with severe sepsis and septic shock was not associated with increased 30-day or 1-year mortality.

UR - http://www.scopus.com/inward/record.url?scp=84863497155&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84863497155&partnerID=8YFLogxK

U2 - 10.1016/j.mayocp.2012.01.018

DO - 10.1016/j.mayocp.2012.01.018

M3 - Article

C2 - 22683055

AN - SCOPUS:84863497155

VL - 87

SP - 620

EP - 628

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

IS - 7

ER -