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Incidence and prognostic impact of myocardial dysfunction in Sepsis and Septic shock


Mowafy H , Omar E , Rizk A , Zaghla H , Rabie A

Abstract

Introduction: The high rate of mortality in the ICU has been attributed to severe sepsis and septic shock. Many studies have pursued the impact of sepsis in inducing dysfunctions in the heart with conflicting results.  Objectives: To evaluate the myocardial dysfunction and tumor necrosis factor-α(TNF- α) as prognosticators of death among these patients. Patients and method: A total of 40 patients complaining from severe sepsis or septic shock participated in this prospective observational investigation. All clinical, biochemical and hematological items were collected. Two echocardiographic examinations were done on all patients: the first as soon as they were admitted, and the second 24hrs later. Generally, systolic dysfunction has been known as LVEF ≤ 50%, whereas, diastolic dysfunction has been known as a reduced septal e-wave velocity ˂ 8 cm/s or E/e ratio > 8 on tissue Doppler imaging (TDI). Results: Fifty percent of the patients developed myocardial dysfunction (systolic and/or diastolic). Diastolic dysfunction incidence was greatly higher than systolic dysfunction (45% versus 15%). Importantly, diastolic dysfunction was associated with higher ICU mortality, while systolic dysfunction did not show any association with mortality. The patients with myocardial dysfunction were older (66.6±18.7 versus 47±20.5, p = 0.003), with elevated values of SOFA and APACHE II score (66.6±18.7 versus 47±20.5, p = 0.003). The concentration of lactate in the serum was higher compared to those who maintained normal cardiac function (7.57±3.86 versus 5.5±1.9, p = 0.008). Of note, serum TNF-αlevels failed to show a correlation with the indication of the presence of systolic or diastolic myocardial dysfunction by ECO. Moreover, this study also showed that in septic subjects, other predictors of death in ICU were: high serum lactate, elevated SOFA and APACHE II scores, increased vasopressor and mechanical ventilation support as well as low cardiac index, drop in the resistance of vascular system and low index of contractility.  Conclusion: Myocardial insufficiency precisely occurred in septic shock and severe sepsis. Diastolic dysfunction was accompanying with higher ICU death, while systolic dysfunction had no impact on mortality. Moreover, TNF-α had no correlation with systolic or diastolic dysfunction confirmed by ECO, and had no effects on the outcomes.




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