• B Munt, J Jue, K Gin, J Fenwick, and M Tweeddale.
• University of British Columbia and Vancouver Hospital and Health Science Center, BC, Canada. bmunt@stpaulshosp.bc.ca
• Crit. Care Med. 1998 Nov 1; 26 (11): 1829-33.

ObjectiveTo determine if nonsurvivors have a more abnormal pattern of left ventricular relaxation than survivors with severe sepsis.DesignProspective, observational, cohort study.SettingIntensive care unit in a university-affiliated tertiary care hospital.PatientsTwenty-four adults with severe sepsis.InterventionsNone.Measurements And Main ResultsBaseline clinical and hemodynamic variables, Acute Physiology and Chronic Health Evaluation (APACHE) II scores and Doppler echocardiographic mitral inflow pattern (analyzed for normalized peak early filling rate [E/VTI, systolic volumes/sec], deceleration time [msec], and early to atrial filling velocity ratio [E/A]). There were seven deaths. The patients did not differ in baseline demographics, inotropic infusions, hemodynamic measurements or ventilatory settings or variables. 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 direction (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 score (p < .02) were the only independent predictors of mortality.ConclusionSevere sepsis nonsurvivors have a more abnormal echocardiographic pattern of left ventricular relaxation than survivors.

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