THE EFFECTS OF CORONARY-ARTERY DISEASE ON CARDIAC-FUNCTION IN NONHYPOTENSIVE SEPSIS

To assess the effects of coronary artery disease on cardiac function in the presence of sepsis, we compared several hemodynamic indices in two groups of septic patients. Group 1 (n=69) consisted of patients with nonhypotensive sepsis without coronary artery disease. Group 2 (n =25) comprised septic patients who had clinical evidence of coronary artery disease. All patients were hemodynamically stable and normotensive at the time of the study. None required inotropic support. While the two groups had similar mean heart rates, mean blood pressures, and biventricular filling pressures, the mean cardiac index was significantly lower in group 2 (3.5 .+-. 0.9 L/min/m2 v 4.4 .+-. 1.2; p < 0.05). This lower cardiac index was related to significantly lower end-diastolic volume indices in group #2, not to differences in contractility between groups. Since the ventricular filling pressures of the groups were similar, the differences in end-diastolic volumes indicate differences in the biventricular compliance. In the presence of hyperdynamic, nonhypotensive sepsis, coronary artery disease was associated with a clinically significant impairment of biventricular compliance, which resulted in a reduction in cardiac output and systemic oxygen transport.