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Characterization of Cardiac Dysfunction by Echocardiography in Early Severe Acute Pancreatitis
Ragesh Babu Thandassery1, Nikhil Choudhary, Ajay Bahl
1From the Departments of *Gastroenterology and †Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Objective:
Persistent organ failure is a feature of severe acute pancreatitis (SAP) and the leading cause of death. Although usually defined by hypotension, cardiovascular dysfunction (CD) in early SAP has not been well characterized. We aim to characterize CD in patients with SAP and hypotension and determine its impact on clinical outcome.
Methods:
Patients with SAP and hypotension were studied to define the frequency, nature, and prognostic significance of CD characterized by echocardiography and classified as systolic, diastolic, or combined dysfunction.
Results:
Of the 72 patients (median age, 41 years, 44 men), 10 (14%) had percutaneous drain placement, 12 (17%) underwent surgery, and 14 (19%) died. Persistent hypotension was present in 58 (81%) and transient hypotension in 14 (19%) patients. Cardiovascular dysfunction was present in 47 (65%) patients: 28 (60%) with diastolic dysfunction, 8 (17%) with systolic dysfunction, and 11 (23%) with combined dysfunction. Left ventricular end diastolic volume, stroke volume index, cardiac index, and diastolic dysfunction correlated with mortality on univariate analysis.
Conclusions:
Two thirds of patients with early SAP and hypotension had cardiac dysfunction, which was most commonly diastolic dysfunction. A better understanding of the nature of cardiac dysfunction in this setting may allow more accurate diagnosis, prognostication, and management.