Authors

• Ivana Lukić — University Hospital Centre Osijek, Osijek, Croatia — ORCID: 0000-0001-9832-6700
• Lana Maričić — University Hospital Centre Osijek, Osijek, Croatia — ORCID: 0000-0001-6035-6760
• Kristina Selthofer-Relatić — University Hospital Centre Osijek, Osijek, Croatia — ORCID: 0000-0002-9890-6489
• Željka Breškić Ćurić — Josip Juraj Strossmayer University of Osijek Faculty of Medicine, Osijek, Croatia — ORCID: 0000-0002-6077-4329

Keywords

echocardiography, myocardial dysfunction, sepsis

DOI

Full Text

**Introduction:** Sepsis is defined as life-threatening organ dysfunction caused by an unregulated host response to infection. (1) Myocardial dysfunction is common in patients with sepsis and septic shock. Establishing the diagnosis of septic cardiomyopathy is a great challenge, and echocardiography as a key diagnostic tool provides several possibilities for the diagnosis of septic cardiomyopathy. Systolic and diastolic dysfunction of the left ventricle is present in 50-60% of patients with sepsis. Right ventricular dysfunction is present in 50-55% of cases, while isolated right ventricular dysfunction is present in 47% of cases. (2, 3) Diastolic dysfunction of the left ventricle is very common in septic shock, and this represents an early biomarker and has prognostic significance. (4) Aim: To examine the influence of sepsis on systolic and diastolic myocardial function in patients with sepsis and septic shock using echocardiographic parameters. **Patients and Methods:** The research included 20 adult patients with a diagnosis of sepsis and septic shock, the sequential organ failure assessment (SOFA) score ≥ 2, hospitalized at the University Hospital Centre Osijek. Each patient underwent two echocardiographic evaluations: the first one on the second day of hospitalization, and the second between the seventh and tenth day of hospitalization for comparison. Key echocardiographic parameters were monitored, which included mitral annular plane systolic excursion (MAPSE), left ventricular ejection fraction according to Simpson biplane, tricuspid annular plane systolic excursion (TAPSE), systolic wave prime (S’) for assessment of left and right ventricular systolic function, and for assessment of left ventricular diastolic function the early diastolic transmitral flow by Doppler (E wave), late diastolic transmitral flow by Doppler (A wave) E/A ratio, mitral annular velocity obtained by tissue Doppler (E`), E/E´ ratio, and isovolumic relaxation time (IVRT). **Results**: In the follow-up examination, compared to the first examination, the values ​​of E` were significantly higher (median 1.0 vs. 0.06) (Wilcoxon test, P = 0.01), and IVRT values were significantly lower (median 81 vs. 99), while there were no other significant differences between measured values in two examinations (**Table 1**). ### TABLE 1: Differences in echocardiography findings at the first and follow-up examination. | | **Median** **(interquartile range)** — **First examination** | **Median** **(interquartile range)** — **Follow-up examination** | **Difference** | **95% CI** | **P*** | | --- | --- | --- | --- | --- | --- | | MAPSE | 12.75 (10 – 15) | 13.0 (10.5 – 14.5) | 0 | -1 do 1 | 0.82 | | TAPSE | 22.5 (20 – 26) | 24.5 (21.5 – 26.5) | 1 | -1 do 3.5 | 0.42 | | E wave | 0.84 (0.7 – 1.05) | 0.76 (0.60 – 0.90) | -0.08 | -0.16 do 0.04 | 0.16 | | A wave | 0.79 (0.6 – 0.89) | 0.75 (0.67 – 0.89) | 0.05 | -0.09 do 0.17 | 0.51 | | E/A | 1.31 (0.83 – 1.50) | 0.9 (0.82 – 1.26) | -0.17 | -0.37 do 0 | 0.06 | | E’ | 0.06 (0.043 – 0.085) | 1.0 (0.06 – 108.0) | 53.9 | 0.03 do 104.9 | 0.01 | | E/E’ | 11.55 (7.8 – 13.9) | 11.0 (0.09 – 14.4) | -2.7 | -5.65 do 1.31 | 0.17 | | IVRT | 99 (90 – 112) | 81 (9.9 – 96.8) | -44.05 | -62.2 do -4.5 | 0.01 | | S’ | 15.0 (13 – 16.75) | 16.0 (14.3 – 16) | 0.75 | -0.5 do 2.0 | 0.09 | | EF Simpson BP | 58.7 (54 – 61.8) | 58.0 (53.0 – 62.3) | -0.55 | -3 do 2.2 | 0.60 | [†] *Wilcoxon test (Hodges-Lehmann`s difference of medians); MAPSE =mitral annular plane systolic excursion; TAPSE = tricuspid annular plane systolic excursion; E wave = early diastolic transmitral flow by Dopple; A wave- late transmitral flow by Doppler; E/A ratio, E` mitral annular velocity by tissue Doppler; E/E` ratio; IVRT = isovolumic relaxation time; S` = sistolic wave prime; EF Simpson BP = left ventricular ejection fraction according to Simpson Biplane **Conclusion:** The results of this study suggest a reversible form of diastolic dysfunction caused by sepsis. It is a common phenomenon in septic cardiomyopathy, where cardiac function can be significantly compromised in the acute phase, but with appropriate treatment, function is restored within a few days.

Literature

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