The prognostic value of left ventricular systolic function measured by tissue Doppler imaging in septic shock

Critical Care, 05/04/2012

Weng L et al. – The study demonstrated that evaluation of left ventricular (LV) systolic function by tissue Doppler imaging (TDI), in particular, Sa, might serve as useful tool to predict mortality in patients with septic shock.

Methods

  • Patients with septic shock in a medical intensive care unit were studied by transthoracic echocardiography with TDI within 24hours after the onset of septic shock.
  • Baseline clinical, laboratory and echocardiographic variables were prospectively collected.
  • Independent predictors of 90–day mortality were analyzed with Cox regression model.

Results

  • During a 20–month period, 61 patients were enrolled in the study.
  • The 90–day mortality rate was 39%; mean APACHE IV score was 84(68–97).
  • Compared with survivors, non–survivors exhibited significantly higher peak systolic velocity measured at mitral annulus (Sa) [11.0(9.1–12.5) vs. 7.8(5.5–9.0)cm/s; p<0.0001], lower PaO2/FiO2 [123(83–187) vs. 186(142–269)mmHg; p=0.002], higher heart rate [120(90–140) vs. 103(90–114)bpm; p=0.004] and higher dose of norepinephrine [0.6(0.2–1.0) vs. 0.3(0.2–0.5)mcg/kg/min; p=0.007].
  • In the multivariate analysis, Sa>9cm/s [hazard ratio (HR) 5.559; 95% confidence interval (CI) 2.160 to 14.305, p<0.0001], dose of norepinephrine (HR 1.964; 95%CI 1.338–2.883, p=0.001) and PaO2/FiO2 (HR 0.992; 95%CI 0.984–0.999, p=0.031) remain independent predictors of 90–day mortality in septic shock patients.

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