PEAK SYSTOLIC PRESSURE END-SYSTOLIC VOLUME RATIO, A LOAD-INDEPENDENT MEASURE OF VENTRICULAR-FUNCTION, IS REVERSIBLY DECREASED IN HUMAN SEPTIC SHOCK

Objective: To evaluate left ventricular performance in patients with s eptic shock, using a load-independent measure of left ventricular syst olic function, the peak systolic pressure/ end-systolic volume index r atio. Setting: National Institutes of Health research facility. Design : Prospective study with retrospective analysis of data. Patients: Twe nty-seven patients with septic shock, 13 critically ill, nonseptic con trol patients, and nine normal volunteers. Measurements: Hemodynamic m easurements from indwelling arterial and pulmonary artery catheters an d radionuclide-determined ejection fraction measurements. These data w ere used to calculate the peak systolic pressure/end-systolic volume i ndex ratio in each patient group. The survivors and nonsurvivors of se ptic shock were evaluated on admission to the intensive care unit and at recovery in the survivors or within 24 hrs of death in the nonsurvi vors. The ratio in each group was compared with the ratio in the criti cally ill, nonseptic patients and the normal volunteers. Main Results: Both survivors and nonsurvivors of septic shock had a decreased peak systolic pressure/end-systolic volume index ratio (1.2 +/- 0.1 and 1.7 +/- 0.2 mm Hg/mL/m(2), respectively) compared with critically ill, no nseptic patients (3.5 +/- 0.7 mm Hg/mL/m(2); both p < .05) and normal volunteers (4.3 +/- 0.4 mm Hg/mL/m(2); both p < .05). The differences between the groups were highly significant (p < .001) by analysis of v ariance. The survivors had a lower initial peak systolic pressure/end- systolic volume index ratio than the nonsurvivors (p < .05). In the su rvivors, the peak systolic pressure/end-systolic volume index ratio in creased significantly (p < .05) with recovery to 2.4 +/- 0.3 mm Hg/mL/ m(2). Serial determinations of peak systolic pressure/endsystolic volu me index ratio in the nonsurvivors did not show any significant change . Conclusions: This study confirms that survivors and nonsurvivors of septic shock have significant depression of myocardial performance as measured by a load-independent technique. Survivors have greater depre ssion of myocardial performance than nonsurvivors, and, with recovery, the ventricular performance in survivors increases toward normal valu es.