Cardiac morphological and functional changes during early septic shock:: a transesophageal echocardiographic study

Objective: The objective was to prospectively evaluate cardiac morphological and functional changes using transesophageal echocardiography (TEE) during early septic shock. Design: Prospective, observational study. Setting: Medical-surgical intensive care unit of a teaching hospital. Patients and participants: Ventilated patients with septic shock, sinus rhythm and no cardiac disease underwent TEE within 12 h of admission (Day 0), after stabilization of hemodynamics by fluid loading (median volume: 4.91 [lower and upper quartiles: 3.7-9.61]) and vasopressor therapy, and after vasopressors were stopped (Day n). Measurements and results: Thirty-five patients were studied (median age: 60 years [range 44-68]; SAPS II: 53 [46-62]; SOFA score: 9 [8-11]) and 9 of them (26%) died while on vasopressors. None of the patients exhibited TEE findings of cardiac preload dependence. Between Day 0 and Day n (7 days [range 6-9]), mean left ventricular (LV) ejection fraction (EF) increased (47 20 vs. 57 +/- 14%: p < 0.05), whereas mean LV end-diastolic volume decreased (97 +/- 25 vs. 75 +/- 20 ml: p < 0.0001). Out of 16 patients (46%) with LV systolic dysfunction on Day 0, 12 had normal LVEF on Day n and 4 patients fully recovered by Day 28. Only 4 women had LV dilatation (range, LV end-diastolic volume: 110-148 ml) on Day 0, but none on Day n. Doppler tissue imaging identified an LV diastolic dysfunction in 7 patients (20%) on Day 0 (3 with normal LVEF), which resolved on Day n. Conclusions: This study confirms that LV systolic and diastolic dysfunctions are frequent, but LV dilatation is uncommon in fluid-loaded septic patients on vasopressors. All abnormalities regressed in survivors, regardless of their severity. Descriptors: Shock: clinical studies (38), Cardiovascular monitoring (34).