P379Myocardial compliance in septic diseases - correlations between left ventricular function and inflammatory status

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Background: Acute left ventricular (LV) dysfunction is common in the critical care setting, frequently observed in patients with severe sepsis and septic shock even in the absence of a systolic impairment. Echocardiography is ideally suited to quantify LV dysfunction and determine its most likely cause.Objective: The aim of this study was to evaluate left ventricular function in severe septic disease, to assess the relationship between left ventricular parameters of the diastolic dysfunction and inflammatory status, to estimate changes in left ventricular compliance and to evaluate the use of echocardiography in the septic disease assessment.Method: 48 patients with septic diseases: 30 with bronchopneumonia and 18 with other infections (urinary, abdominal abscess, peripheral gangrene) without known coronary arterial disease and without other known cardiovascular pathology. They underwent clinical exam, inflammatory tests, and echocardiography. We used Tissue Doppler Imaging, color M mode (E/E', E/Vp) to evaluate the end-diastolic pressure-volume. PORT score was used to asses the disease severity in patients with bronchopneumonia.Results: 32 patients (67%) showed elevated E/E' ratio (median 18; 10-26). Echocardiography ruled out systolic impairment in 36 patients (75%). There is a positive correlation, statistically significant between E/TDI E' ratio and C Reactive Protein (p<0.001), between E/E'and PORT score (Pearson correlation=, 473), between E/Vp and poor outcome (Pearson correlation =, 604).Conclusions: Echocardiography is ideally suited to quantify LV dysfunction and determine its most likely cause, to evaluated the effects of sepsis on the end-diastolic pressure-volume in the left ventricle The decrease in compliance (suggesting diastolic dysfunction) occurred prior to systolic impairment, which may have valuable prognostic implications for septic patients.

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