A Circulating Myocardial Depressant Substance is Associated with Cardiac Dysfunction and Peripheral Hypoperfusion: Cardiovascular Function

In: Septic Shock

5 Nov 2014

A Circulating Myocardial Depressant Substance is Associated with Cardiac Dysfunction and Peripheral Hypoperfusion: Cardiovascular FunctionCardiovascular Function
The serial changes in mean EF, as determined by radionuclide cineangiography, are analyzed in Figure 1. The group of 14 patients with MDS had an initial (day 0 to 1) mean EF of 40 percent that fell to 28 percent at the follow-up scan (days 2 to 4). This second mean EF is lower than the initial EF (p<0.05). The recovery (seven to ten days) mean EF of 51 percent is higher than the second EF (p<0.001).

The group of 20 patients without MDS had an initial mean EF of 42 percent, a follow-up EF of 39 percent, and a recovery EF of 46 percent. None of these serial changes is statistically significant. The patients with MDS have a lower follow-up (days 2 to 4) mean EF than the patients without MDS (28 percent vs 39 percent, p<0.05). These statistical relationships hold using either paired or unpaired Students t tests.
Radionuclide cineangiographic results of the MDS-positive and MDS-negative patients are compared further in Figures 2A and 2B. The lowest EF obtained during the critical care unit stay in patients with MDS and without MDS are shown in Figure 2A. The lowest mean EF is 28.0 in the patients with MDS and 39.3 in the patients without MDS (p = 0.01). Figure 2B illustrates the maximum change in EF that occurred for each patient. The mean difference from initial to lowest EF was 22.1 percent among patients with MDS and 8.8 percent among patients without MDS (p = 0.002). so

Table 1 compares laboratory, hemodynamic, and radionuclide cineangiographic characteristics of septic shock patients with and without MDS. The following laboratory parameters were found to be equivalent between the two groups of patients: creatinine, bilirubin, prothrombin time, mixed venous oxygen tension, and leukocyte count. Peak lactic acid levels during septic shock were significantly higher in patients with MDS. Of the hemodynamic parameters evaluated, EDVI and PAWP were significantly higher in patients with MDS. The EDVI was calculated at follow-up scan (two to four days); the PAWP was measured at the time of the initial hemodynamic studies.

Figure 1. Changes in EF during septic shock in patients with (dashed line) and without (solid line) MDS. Comparing serial changes in patients with MDS the 2- to 4-day mean EF was lower (p<0.05) than the 0- to 1-day value, and the 5- to 7-day mean EF was higher (p<0.001) than the 2- to 4-day value. The serial mean EFs in patients without MDS did not change significantly. Comparing MDS—positive with MDS—negative patients at two to four days, the patients with MDS had a lower mean EF than patients without MDS (28 percent vs 39 percent, p<0.05).

Figure 1. Changes in EF during septic shock in patients with (dashed line) and without (solid line) MDS. Comparing serial changes in patients with MDS the 2- to 4-day mean EF was lower (p<0.05) than the 0- to 1-day value, and the 5- to 7-day mean EF was higher (p<0.001) than the 2- to 4-day value. The serial mean EFs in patients without MDS did not change significantly. Comparing MDS—positive with MDS—negative patients at two to four days, the patients with MDS had a lower mean EF than patients without MDS (28 percent vs 39 percent, p<0.05).

Figure 2. The lowest EF (2A) and the maximum change in EF (2B) during the course of septic shock in the 14 patients with MDS and the 20 patients without MDS.

Figure 2. The lowest EF (2A) and the maximum change in EF (2B) during the course of septic shock in the 14 patients with MDS and the 20 patients without MDS.

Table 1—Characteristics of 14 Fatients tcith MDS and 20 Patients without MDS

Characteristics Patient Groups
MDS Positive (N = 14) MDS Negative (N = 20) PValue
Laboratory!
Lactate, mmol/L 6.9±1.7$ 2.7±0.4 <0.01
Creatinine, mg/dl 2.1±0.3 1.9±0.3 NS
Prothrombin time, s 15.4 ±1.3 15.3 ±0.6 NS
Mixed venous 02, mm Hg 37.6± 1.6 37.3 ±4.1 NS
Leukocytes, xlOVmm 23.0±1.7 7.4±4.1 NS
Bilirubin, mg/dl 4.5±2.1 2.5±0.6 NS
Hemodynamics§
Heart rate, mnr 127.1 ±4.4 121.2±5.0 NS
MAP, mm Hg 64.0±3.0 70.6±3.8 NS
Cardiac index, L/min/m* 6.3± 1.1 5.2 ±0.5 NS
PAWP, mm Hg 16.8± 1.7 11.9±0.8 <0.01
SVI, ml/m* 41.7±4.5 43.5±4.0 NS
EDVI, ml/m* 162.2 ±15.8 118.2±9.8 = 0.02
SVR, dynes-s/cm 580 ±140 855 ±107 NS
Norepinephrine, jig/min 25.8± 11.8 13.3 ±10.8 NS
Dopamine, jig/kg/min 12.9 ±2.7 7.7 ±2.0 NS
Radionuclide cineangiograms
Initial EF 39.7 ±4.5 41.6±2.4 NS
Follow-up EF 28.0±3.4 39.3 ±2.7 = 0.01
Recovery EF 50.8±3.6 46.2±3.1 NS

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