Author:
Chauvet Jean-Louis,El-Dash Shari,Delastre Olivier,Bouffandeau Bernard,Jusserand Dominique,Michot Jean-Baptiste,Bauer Fabrice,Maizel Julien,Slama Michel
Abstract
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 cm2/m2 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.
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
Reference23 articles.
1. Braunwald E, Lambrew CT, Rockoff SD, Ross Jr J, Morrow AG. Idiopathic hypertrophic subaortic stenosis. I. A description of the disease based upon an analysis of 64 patients. Circulation. 1964;30:3–119.
2. Henry WL, Clark CE, Epstein SE. Asymmetric septal hypertrophy: echocardiographic identification of the pathognomonic anatomic abnormality of IHSS. Circulation. 1973;47:225–33.
3. Panza JA, Maris TJ, Maron BJ. Development and determinants of dynamic obstruction to left ventricular outflow in young patients with hypertrophic cardiomyopathy. Circulation. 1992;85:1398–405.
4. Chockalingam A, Dorairajan S, Bhalla M, Dellsperger KC. Unexplained hypotension: the spectrum of dynamic left ventricular outflow tract obstruction in critical care settings. Crit Care Med. 2009;37:729–34.
5. Yang JH, Park SW, Yang JH, et al. Dynamic left ventricular outflow tract obstruction without basal septal hypertrophy, caused by catecholamine therapy and volume depletion. Korean J Intern Med. 2008;23:106–9.
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