Discussing About The Characters Of Left Ventricular Structure And Function And Their Clinical Significance In Septic Patients

Objective To investigate the various changes of left ventricular structure and function and their clinical significance in septic patients.Methods A prospective observational study was conducted, in which 84 patients with sepsis admitted in the Emergency Center of TianJin Medical University General Hospital from October 2008 to July 2009 were enrolled as patient group and 20 healthy volunteers as control group. Cases with acute myocardial infarction, obsolete myocardial infarction, ischemic cardiomyopathy, hypertensive heart disease, primary cardiomyopathy, metabolic cardiomyopathy, cor pulmonale, valvular heart disease, congenital heart disease, myocarditis and infective endocarditis were excluded. Serial transthoracic echocardiography was performed for all the patients at dayl,3,7,10 after admitting, the change of LVEDD, LVEF and E/A were recorded. Serum level of IL-6, IL-10 and cTnT were measured within 24 hours, the same as control group. Clinical information of each patient was recorded, including underlying desease, infected sources, pathogeny, APACHEⅡscore and prognosis. Satistical analysises were performed with SPSS 16.0 and MedCalcll.3. After comparation, we made correlation analysis of meaningful indexes with LVEDD, LVEF and E/A, and got their most optimal cut-point, sensitinity, specificity,+PV and—PV of predicting the change of cardiac function. The independent risk factors for prognosis were shown by multinomial logistic regression analysis and ROC analysis.Results Three types of the left ventricular function were shown:51 patients with normal LVEDD, normal LVEF and decreased E/A(typeⅠ); 18 patients with enlarged LVEDD, normal LVEF and decreased E/A (typeⅡ); 15 patients with enlarged LVEDD, decreased LVEF and decreased E/A(typeⅢ). The changes of survivors were reversible. No significantly differences were found in patients'age, gender, underlying disease, infected source and the kind of pathogeny among the three types. Septic patients had significantly higher IL-6 and IL-10 compared to those in control group. In patient group(p<0.01), IL-6 levels were significantly higher in type and typeⅢthan in typeⅡ(p<0.05). There were no significantly differences of IL-6 in typeⅠand typeⅢ(p>0.05). No significant difference of IL-10 levels were found in the three patients group (p>0.05). Patients in typeⅢhad significantly higher cTnT levels compared to those of other two patient groups (p<0.01). Serum level of IL-6 showed negative corelation with LVEF (rs=-0.280, p<0.05) and no correlation with LVEDD (rs=0.011, p>0.05). Serum level of cTnT showed positive correlation with LVEDD (rs=0.451,p<0.001) and negative corelation with LVEF (rs=-0.247, p<0.05). Neither of them showed correlation with E/A (p>0.05). The area under ROC curve of cTnT predictiving typeⅢwas more than IL-6 (p<0.001). The most optimal cut-point, sensitinity, specificity,+PV and—V of cTnT predicting typeⅢwere 0.03ng/ml, 90.00%,80.80%,50.00% and 100.00%, of IL-6 were 15.04pg/ml,90.00%,69.60%, 30.00% and 96.97%, respectively.Patients in typeⅢhad significantly highe APACHEⅡscore (p<0.01), incidence of shock and MODS (p<0.05) compared to patients in the other two patient groups. There were no significant differences of APACHEⅡscore, the incidence of shock and MODS in typeⅠand typeⅡ. Mortality were significant different in the rank order of typeⅡ(0)0.05).Conclusion①Most septic patients show impairment in left ventricular diastolic function and a part of them accompanied with left ventricular systolic dysfunction. All the changes are reversible in survivors.②Inflammation and injury of myocardial cells contribute to the enlargement of left ventricular and systolic dysfunction. The elevating of Serum level of IL-6 and cTnT are helpful to prognostic predicting of cardiac function in septic patients.③Septic patients with dialation of left ventricular and systolic and diastolic dysfunction show poor prognosis. Investigating the changes of left ventricular structure and function can be helpful to the prognostic predicting of septic patients.④The physiology of dilatation of left ventricular without systolic dysfunction still needs more research.⑤Transthoracic echocardiography is an effective, noninvasive and convenient method to evaluate cardiac function. LVEDD, LVEF and E/A are three available indexs to evaluate left ventricular structure and function.