ASSESSMENT OF LEFT-VENTRICULAR FUNCTION IN SEVERE SCORPION ENVENOMATION - COMBINED HEMODYNAMIC AND ECHO-DOPPLER STUDY

Objective: To assess left ventricular function in patients presenting with pulmonary edema following scorpion envenomation. Design: Cohort s tudy. Setting: Medical intensive care unit of a teaching hospital. Pat ients: Nine consecutive adult patients stung by Androctonus australis and presenting with pulmonary edema entered the study. Fourteen normal volunteers comprised the control group. Interventions: Upon admission , all patients had right heart catheterization and, within the first 8 h, a Doppler echocardiographic study. Results of Doppler echocardiogr aphic studies were compared to those of controls. Measurements and res ults: Usual hemodynamic information (heart and vascular pressures, der ived data and tissue oxygenation parameters), left ventricular dimensi ons and indicators of systolic function, and Doppler-derived parameter s of left ventricular filling and diastolic function were obtained upo n admission. Serial echocardiographic measurements were repeated daily until full clinical recovery (eight patients) or death (one patient). All patients had a hemodynamic profile of acute congestive heart fail ure (mean PAOP = 24 +/- 2 mmHg; mean SVI = 22 +/- 7 ml/m(2); mean CI = 2.5 +/- 0.5 l/min/m(2)). However, SVR were not increased (mean = 22 /- 3 U/m(2)). Left ventricle was hypokinetic in all patients with tran sient mitral regurgitation present in five patients. Left ventricular systolic function was markedly depressed (FS = 12 +/- 6%; EF = 26 +/- 12%). An associated diastolic dysfunction is suggested by Doppler reco rds of mitral inflow. Left ventricular systolic function evolved towar d normalization within 6 +/- 2 days preceded by full clinical recovery . Conclusions: These data suggest that pulmonary edema in scorpion env enomation is of hemodynamic origin and is related to a severe and prom inent impairment of left ventricular systolic function.