Evaluation of different patterns of sepsis-induced myocardial dysfunction by echocardiographic tissue Doppler imaging as early predictors of mortality
HanyE Elsayed, TayseerM Zaytoun, TamerA Helmy, MarwanM El Bourini
Abstract
Background Cardiovascular dysfunction in sepsis is associated with a significantly increased mortality rate. Tissue Doppler imaging is useful in detecting sepsis-induced myocardial dysfunction (SIMD) by quantification of systolic and diastolic functions.Aim To evaluate the different patterns of SIMD, by pulsed-wave tissue Doppler imaging (pwTDI), as early predictors of mortality.Settings and design A prospective observational cross-sectional study was conducted.Patients and methods Our study included 120 patients with severe sepsis/septic shock. All patients were assessed during the first 24 h of diagnosis using transthoracic echocardiography. Tissue velocities were obtained by pwTDI, and patterns of SIMD were determined and correlated with the patients’ outcome.Results In the systolic dysfunction group, a cutoff value for peak systolic annular velocity (S′) of more than 5.8 cm/s was associated with significant mortality, whereas in diastolic dysfunction group, a cutoff value for early diastolic transmitral flow velocity to early diastolic mitral annular tissue velocity (E/e′) of more than 12.5 was associated with significant mortality. In the combined dysfunction group, a cutoff value for S′ of less than 5.2 cm/s and a cutoff value for E/e′ of more than 12 were associated with significant mortality. Regarding the hyperkinetic group, a cutoff value for S′ of more than 11 cm/s was associated with significant mortality.Conclusion Tissue velocities measured by pwTDI were able to predict mortality in patients with severe sepsis/septic shock, with the highest mortality in the hyperkinetic pattern, whereas left ventricular systolic dysfunction was common in survivors, with the lowest mortality rate.