Related Experiment Video
Updated: Mar 9, 2026
Real-time Pressure-volume Analysis of Acute Myocardial Infarction in Mice
Published on: July 2, 2018
Characterization of Myocardial Dysfunction in Fluid- and Catecholamine-Refractory Pediatric Septic Shock and Its
Feifei Z Williams1, Ritu Sachdeva2,3,4, Curtis D Travers5
11 Division of Pediatric Critical Care Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Insights
Myocardial dysfunction is common in pediatric septic shock (PSS) but not linked to mortality. Left ventricular dysfunction correlates with illness severity, while right ventricular dysfunction is associated with cold shock.
Area of Science:
- Pediatric critical care medicine
- Cardiology
- Septic shock research
Background:
- Myocardial dysfunction is a known complication in pediatric septic shock (PSS).
- The clinical significance and prevalence of myocardial dysfunction in PSS remain unclear.
- Echocardiography is a key tool for assessing cardiac function.
Purpose of the Study:
- To characterize left ventricular (LV) and right ventricular (RV) dysfunction in PSS using echocardiography.
- To determine the prevalence of LV and RV dysfunction in PSS.
- To investigate the association of myocardial dysfunction with illness severity and clinical outcomes in PSS.
Main Methods:
- Retrospective chart review of 78 patients with PSS in pediatric intensive care units.
- Echocardiographic assessment of LV and RV systolic and diastolic function.
- Correlation of echocardiographic parameters with severity scores (PRISM III, PELD), vasoactive-inotrope score (VIS), BNP, lactate, shock type, mechanical ventilation, and mortality.
Main Results:
- High prevalence of LV dysfunction (72%) and RV dysfunction (63%) in PSS.
- LV systolic dysfunction associated with higher PRISM III, VIS, and BNP levels.
- RV systolic dysfunction associated with cold shock; no significant associations for diastolic dysfunction.
- No echocardiographic measures were significantly associated with 28-day mortality.
Conclusions:
- Myocardial dysfunction is highly prevalent in PSS but does not predict mortality.
- LV systolic dysfunction indicates greater illness severity and higher vasoactive use.
- RV systolic dysfunction is linked to cold shock presentation.
- Further research is needed to clarify the role of echocardiography in PSS management.
Purpose::
Myocardial dysfunction is a known complication in patients with pediatric septic shock (PSS); however, its clinical significance remains unclear. The purpose of this study was to characterize left ventricular (LV) and right ventricular (RV) dysfunction and their prevalence in patients with PSS using echocardiography (echo) and to investigate their associations with the severity of illness and clinical outcomes.
Methods::
Retrospective chart review between 2010 and 2015 from 2 tertiary care pediatric intensive care units. Study included 78 patients (mean age 9.3 ± 7 years) from birth up to 21 years who fulfilled criteria for fluid- and catecholamine-refractory septic shock. Echocardiographic parameters of systolic, diastolic, and global function were measured offline. They were correlated with admission Pediatric Risk of Mortality III (PRISM III) and Pediatric Logistic Organ Dysfunction scores, vasoactive-inotrope score (VIS), β-type natriuretic peptide (BNP), lactate, type of shock, duration of mechanical ventilation (MV), intensive care unit and hospital length of stay, and mortality.
Results::
Overall, 28-day mortality was 26%, and 88% patients required MV. Prevalence of LV dysfunction was 72% and RV dysfunction was 63%. LV systolic dysfunction (fractional shortening z score <-2) was significantly associated with PRISM III, VIS, and BNP. RV systolic dysfunction (tricuspid annular plane systolic excursion z score <-2) was significantly associated with cold shock. LV and RV diastolic dysfunction did not have any significant clinical associations. No echocardiographic measures were associated with mortality.
Conclusion::
Myocardial dysfunction is highly prevalent in PSS but is not associated with mortality. LV systolic dysfunction is associated with a higher severity of illness, use of vasoactives, and BNP, whereas RV systolic dysfunction is associated with cold shock. Further studies are needed to determine the utility of echo in the bedside management of patients with PSS.
Related Concept Videos
01:29Heart Failure II: Pathophysiology
01:17Pathophysiology of Heart Failure
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:21Myocarditis I: Introduction