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Early dynamic left intraventricular obstruction is associated with hypovolemia and high mortality in septic shock patients.

Chauvet JL, El-Dash S, Delastre O, Bouffandeau B, Jusserand D, Michot JB, Bauer F, Maizel J, Slama M - Crit Care (2015)

Bottom Line: Small, hypercontractile left ventricles (end-diastolic left ventricular surface 4.7 ± 2.1 cm(2)/m(2) and ejection fraction 82 ± 12%), and frequent pseudohypertrophy were found in these patients.A rise ≥12% in stroke index was found in 87% of patients with IVO, with a drop of 47% in IVO after fluid infusion.The mortality rate was found to be higher in these patients in comparison with patients without obstruction.

View Article: PubMed Central - PubMed

Affiliation: General Intensive Care Unit, Elbeuf Intercommunal Hospital Center, Elbeuf, France. jean-louis.chauvet@chi-elbeuf-louviers.fr.

ABSTRACT

Introduction: Based on previously published case reports demonstrating dynamic left intraventricular obstruction (IVO) triggered by hypovolemia or catecholamines, this study aimed to establish: (1) IVO occurrence in septic shock patients; (2) correlation between the intraventricular gradient and volume status and fluid responsiveness; and (3) mortality rate.

Method: We prospectively analyzed patients with septic shock admitted to a general ICU over a 28-month period who presented Doppler signs of IVO. Clinical characteristics and hemodynamic parameters as well as echocardiographic data regarding left ventricular function, size, and calculated mass, and left ventricular outflow Doppler pattern and velocity before and after fluid infusions were recorded.

Results: During the study period, 218 patients with septic shock were admitted to our ICU. IVO was observed in 47 (22%) patients. Mortality rate at 28 days was found to be higher in patients with than in patients without IVO (55% versus 33%, p < 0.01). Small, hypercontractile left ventricles (end-diastolic left ventricular surface 4.7 ± 2.1 cm(2)/m(2) and ejection fraction 82 ± 12%), and frequent pseudohypertrophy were found in these patients. A rise ≥12% in stroke index was found in 87% of patients with IVO, with a drop of 47% in IVO after fluid infusion.

Conclusion: Left IVO is a frequent event in septic shock patients with an important correlation with fluid responsiveness. The mortality rate was found to be higher in these patients in comparison with patients without obstruction.

No MeSH data available.


Related in: MedlinePlus

Pseudohypertrophy. Echocardiography in the parasternal short axis view. Ventricular wall appear thickened in these two-dimensional images, despite LV mass being unchanged. a The reduction in LVEDD size of the left ventricle (LV). b The near obliteration of the ventricular lumen in systole (“kissing” walls)
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Fig3: Pseudohypertrophy. Echocardiography in the parasternal short axis view. Ventricular wall appear thickened in these two-dimensional images, despite LV mass being unchanged. a The reduction in LVEDD size of the left ventricle (LV). b The near obliteration of the ventricular lumen in systole (“kissing” walls)

Mentions: Though only two patients had previously diagnosed myocardial hypertrophy, 30 patients (64 %) exhibited thickened myocardial walls at the time of the first examination: 20 (43 %) had an end-diastolic posterior wall thickness ≥12 mm, 2 (4 %) had a septal end-diastolic thickness ≥13 mm and 9 (19 %) had a maximum thickness septal bulge ≥15 mm. In the majority of these patients (16 cases) we were able to calculate ventricular mass [14] and found that in 81 % of them (13 cases) the calculated LV mass was within the range of normality, despite the apparent thickening, and that, therefore, the wall thickening seen on two-dimensional echocardiography was actually pseudohypertrophy (Fig. 3).Fig. 3


Early dynamic left intraventricular obstruction is associated with hypovolemia and high mortality in septic shock patients.

Chauvet JL, El-Dash S, Delastre O, Bouffandeau B, Jusserand D, Michot JB, Bauer F, Maizel J, Slama M - Crit Care (2015)

Pseudohypertrophy. Echocardiography in the parasternal short axis view. Ventricular wall appear thickened in these two-dimensional images, despite LV mass being unchanged. a The reduction in LVEDD size of the left ventricle (LV). b The near obliteration of the ventricular lumen in systole (“kissing” walls)
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4522114&req=5

Fig3: Pseudohypertrophy. Echocardiography in the parasternal short axis view. Ventricular wall appear thickened in these two-dimensional images, despite LV mass being unchanged. a The reduction in LVEDD size of the left ventricle (LV). b The near obliteration of the ventricular lumen in systole (“kissing” walls)
Mentions: Though only two patients had previously diagnosed myocardial hypertrophy, 30 patients (64 %) exhibited thickened myocardial walls at the time of the first examination: 20 (43 %) had an end-diastolic posterior wall thickness ≥12 mm, 2 (4 %) had a septal end-diastolic thickness ≥13 mm and 9 (19 %) had a maximum thickness septal bulge ≥15 mm. In the majority of these patients (16 cases) we were able to calculate ventricular mass [14] and found that in 81 % of them (13 cases) the calculated LV mass was within the range of normality, despite the apparent thickening, and that, therefore, the wall thickening seen on two-dimensional echocardiography was actually pseudohypertrophy (Fig. 3).Fig. 3

Bottom Line: Small, hypercontractile left ventricles (end-diastolic left ventricular surface 4.7 ± 2.1 cm(2)/m(2) and ejection fraction 82 ± 12%), and frequent pseudohypertrophy were found in these patients.A rise ≥12% in stroke index was found in 87% of patients with IVO, with a drop of 47% in IVO after fluid infusion.The mortality rate was found to be higher in these patients in comparison with patients without obstruction.

View Article: PubMed Central - PubMed

Affiliation: General Intensive Care Unit, Elbeuf Intercommunal Hospital Center, Elbeuf, France. jean-louis.chauvet@chi-elbeuf-louviers.fr.

ABSTRACT

Introduction: Based on previously published case reports demonstrating dynamic left intraventricular obstruction (IVO) triggered by hypovolemia or catecholamines, this study aimed to establish: (1) IVO occurrence in septic shock patients; (2) correlation between the intraventricular gradient and volume status and fluid responsiveness; and (3) mortality rate.

Method: We prospectively analyzed patients with septic shock admitted to a general ICU over a 28-month period who presented Doppler signs of IVO. Clinical characteristics and hemodynamic parameters as well as echocardiographic data regarding left ventricular function, size, and calculated mass, and left ventricular outflow Doppler pattern and velocity before and after fluid infusions were recorded.

Results: During the study period, 218 patients with septic shock were admitted to our ICU. IVO was observed in 47 (22%) patients. Mortality rate at 28 days was found to be higher in patients with than in patients without IVO (55% versus 33%, p < 0.01). Small, hypercontractile left ventricles (end-diastolic left ventricular surface 4.7 ± 2.1 cm(2)/m(2) and ejection fraction 82 ± 12%), and frequent pseudohypertrophy were found in these patients. A rise ≥12% in stroke index was found in 87% of patients with IVO, with a drop of 47% in IVO after fluid infusion.

Conclusion: Left IVO is a frequent event in septic shock patients with an important correlation with fluid responsiveness. The mortality rate was found to be higher in these patients in comparison with patients without obstruction.

No MeSH data available.


Related in: MedlinePlus