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ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 75-83

Evaluation of different patterns of sepsis-induced myocardial dysfunction by echocardiographic tissue Doppler imaging as early predictors of mortality


Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Correspondence Address:
PhD Hany E Elsayed
Mostafa Kamel Street At Intersection With Street 313, El-Marwa Building, Smouha, Alexandria, 21431
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/roaic.roaic_65_18

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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.


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