The Prognostic Value Of Left Ventricular Function Measured By Tissue Doppler Imaging In Septic Shock:the Weaker, The Better

Background:Left ventricular (LV)dysfunction is common in septic shock. Its association with clinical outcome is still controversial. Tissue Doppler imaging (TDI) is a useful tool to quantify LV function, however, few knowledge is available about the prognostic value of these TDI variables in septic shock. Therefore, we performed this prospective study to determine the role of TDI variables in septic shock.Methods:Patients with septic shock in a medical intensive care unit were studied by transthoracic echocardiography with TDI within24hours after the onset of septic shock. Baseline clinical, laboratory and echocardiographic variables were prospectively collected. Independent predictors of90-day mortality were analyzed with Cox regression model.ResuIts.’During a20-month period,61patients were enrolled in the study. The90-day mortality rate was39%;mean APACHE IV score was84±22. Compared with survivors, non-survivors exhibited significantly higher peak systolic velocity measured at mitral annulus (Sa)(11.0±3.1vs.7.5±2.1cm/s; p<0.0001), lowerPaO2/FiO2(141±67vs.210±86mmHg; p=0.002),higher heart rate (119±28vs.102±16bpm; p=0.004)and higher dose of norepinephrine [0.6(0.2-1.0) vs.0.3(0.2-0.5)mcg/kg/min; p=0.007]. In the multivariate analysis, Sa>9cm/s [hazard ratio (HR)5.559;95%confidence interval (CI)2.160to14.305, p<0.0001], dose of norepinephrine (HR1.964;95%CI1.338-2.883, p=0.001) and PaO2/FiO2(HR0.992;95%CI0.984-0.999, p=0.031)remain independent predictors of90-day mortality in septic shock patients.Conclusions:Evaluation of LV systolic function by TDI may serve as useful tool to predict survival in patients with septic shock. Compared with non-survivors, survivors exhibited more significant myocardial depressionas shown by lower Sa on ICU admission.