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Diastolic filling in human severe sepsis: an echocardiographic study
1University of British Columbia and Vancouver Hospital and Health Science Center, BC, Canada. bmunt@stpaulshosp.bc.ca
Objective:
To determine if nonsurvivors have a more abnormal pattern of left ventricular relaxation than survivors with severe sepsis.
Design:
Prospective, observational, cohort study.
Setting:
Intensive care unit in a university-affiliated tertiary care hospital.
Patients:
Twenty-four adults with severe sepsis.
Interventions:
None.
Measurements And Main Results:
Baseline clinical and hemodynamic variables, Acute Physiology and Chronic Health Evaluation (APACHE) II scores and Doppler echocardiographic mitral inflow pattern (analyzed for normalized peak early filling rate [E/VTI, systolic volumes/sec], deceleration time [msec], and early to atrial filling velocity ratio [E/A]). There were seven deaths. The patients did not differ in baseline demographics, inotropic infusions, hemodynamic measurements or ventilatory settings or variables. Nonsurvivors had a more abnormal pattern of left ventricular relaxation (E/VTI, 4.7 [range 3.8 to 5.8] vs. 5.8 [range 3.8 to 8.9], p= .04; deceleration time, 235 [range 209 to 367] vs. 182 [range 155 to 255], p = .002). E/A showed a nonsignificant trend in the same direction (0.9 [range 0.8 to 1.6] vs. 1.2 [range 0.7 to 1.9], p = .12). In a multivariate analysis, deceleration time (p< .004) and APACHE II score (p < .02) were the only independent predictors of mortality.
Conclusion:
Severe sepsis nonsurvivors have a more abnormal echocardiographic pattern of left ventricular relaxation than survivors.