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Acute left ventricular dilatation and shock-induced myocardial dysfunction*

Bouhemad, Bélaïd MD, PhD; Nicolas-Robin, Armelle MD; Arbelot, Charlotte MD; Arthaud, Martine PharmD; Féger, Frédéric PharmD, PhD; Rouby, Jean-Jacques MD, PhD

doi: 10.1097/CCM.0b013e318194ac44
Continuing Medical Education Article
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CME

Objective: Whether cardiac ventricles can acutely dilate during septic myocardial dysfunction.

Design: A prospective echocardiographic study was performed to assess changes of left ventricular dimensions over time in patients with septic shock.

Settings: A 20-bed surgical intensive care unit of Pitié-Salpêtrière university hospital in Paris.

Patients: Forty-five patients were studied over the first 10 days of septic shock.

Interventions: None.

Measurements and Main Results: Left ventricular end-diastolic area (LVEDA), fractional area change (FAC), velocity time integral of the aortic flow, echocardiographic indices of left ventricular relaxation, and cardiac troponin I (cTnI) were measured at day 1, 2, 3, 4, 7, and 10. Three groups were defined: 29 patients without increased cTnI and cardiac impairment (group 1), eight patients with increased cTnI and left systolic ventricular dysfunction (group 2), and eight patients with increased cTnI and isolated impairment of left ventricular relaxation (group 3). At day 1, LVEDA was significantly higher in group 2 (13 ± 3 cm/m2, p < 0.05) compared with groups 1 (10 ± 2 cm/m2) and 3 (11 ± 2 cm/m2). LVEDA did not change in groups 1 and 3. In group 2, LVEDA and FAC returned within 10 days to values observed in groups 1 and 2. A significant correlation was found between aortic velocity time integral and LVDEA (r =.78, p = 0.022) and FAC (r =.89, p = 0.003) only in group 2.

Conclusions: Acute and reversible left ventricular dilation accompanies septic shock-induced systolic left ventricular dysfunction. When septic myocardial abnormalities are limited to reversible impairment of left ventricular relaxation, left ventricular dimensions remain unchanged.

Hospital Practitioner (BB, ANR), Department of Anesthesiology, Réanimation Chirurgicale Pierre Viars, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, University Pierre et Marie Curie Paris-6, France; Associate Professor (CA), Department of Anesthesiology Réanimation Chirurgicale Pierre Viars, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, University Pierre et Marie Curie Paris-6, France; Hospital Practitioner (MA, FF), Laboratoire de Biologie des Urgences (MA, FF), Assistance Publique Hôpitaux de Paris, Hospital Pitié-Salpêtrière, University Pierre et Marie Curie Paris-6, France; Hospital Practitioner (FF), Faculté de Pharmacie, Paris, France; and Medical Director (JJR), Department of Anesthesiology, Réanimation Chirurgicale Pierre Viars, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, University Pierre et Marie Curie Paris-6, France.

For information regarding this article, E-mail: belaid.bouhemad@psl.aphp.fr

© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins