DIASTOLIC FILLING IN HUMAN SEVERE SEPSIS - AN ECHOCARDIOGRAPHIC STUDY

Objective: To determine if nonsurvivors have a more abnormal pattern o f left ventricular relaxation than survivors with severe sepsis. Desig n: Prospective, observational, cohort study. Setting: Intensive care u nit in a university-affiliated tertiary care hospital. Patients: Twent y-four adults with severe sepsis. Interventions: None. Measurements an d Main Results: Baseline clinical and hemodynamic variables, Acute Phy siology and Chronic Health Evaluation (APACHE) II scores and Doppler e chocardiographic mitral inflow pattern (analyzed for normalized peak e arly filling rate [E/VTI, systolic volumes/sec], deceleration time [ms ec], and early to atrial filling velocity ratio [EIA]). There were sev en deaths. The patients did not differ in baseline demographics, inotr opic infusions, hemodynamic measurements or ventilatory settings or va riables. Nonsurvivors had a more abnormal pattern of left ventricular relaxation (E/VTI, 4.7 [range 3.8 to 5.8] vs. 5.8 [range 3.8 to 8.9], p = .04; deceleration time, 235 [range 209 to 367] vs. 182 [range 155 to 255], p = .002). E/A showed a nonsignificant trend in the same dire ction (0.9 [range 0.8 to 1.6] vs. 1.2 [range 0.7 to 1.9], p = .12). In a multivariate analysis, deceleration time (p < .004) and APACHE II s core (p < .02) were the only independent predictors of mortality. Conc lusion: Severe sepsis nonsurvivors have a more abnormal echocardiograp hic pattern of left ventricular relaxation than survivors.