Early dynamic left intraventricular obstruction in septic shock patients was associated with significantly higher 28-day mortality compared to patients without obstruction (55% vs 33%, OR 2.23).
Observational (n=218)
No
Does the presence of early dynamic left intraventricular obstruction predict fluid responsiveness and mortality in patients with septic shock?
Early dynamic left intraventricular obstruction is common in septic shock, indicates severe hypovolemia with high fluid responsiveness, and is independently associated with increased 28-day mortality.
Effect estimate: OR 2.23 (95% CI 1.08-4.58)
Absolute Event Rate: 55% vs 33%
p-value: p=0.03
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 cm(2)/m(2) 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.
Chauvet et al. (Wed,) conducted a observational in Septic shock (n=218). Left intraventricular obstruction (IVO) vs. No left intraventricular obstruction was evaluated on 28-day mortality (OR 2.23, 95% CI 1.08-4.58, p=0.03). Early dynamic left intraventricular obstruction in septic shock patients was associated with significantly higher 28-day mortality compared to patients without obstruction (55% vs 33%, OR 2.23).