Cardiac Contractile Reserve Parameters Are Related to Prognosis in Septic Shock

Abstract

Introduction. Cardiac reserve could be defined as the spontaneous magnitude from basal to maximal cardiac power under stress conditions. The aim of this study was to evaluate the prognostic value of cardiac reserve parameters in resuscitated septic shock patients. Methods. Seventy patients with septic shock were included in a prospective and observational study. Prior to inclusion, patients were resuscitated to reach a mean arterial pressure of 65–75 mmHg with an euvolemic status. General, hemodynamic, and cardiac reserve-related parameters (cardiac index, double product, and cardiac power index) were collected at inclusion and at day 1. Results. Seventy patients were included with 28-day mortality at 38.5%. Ten of the 70 patients died during the first day. In multivariate analysis, independent predictors of death were SAPS II ≥58 (OR: 3.36 [1.11–10.17]; P = 0.032), a high double product at inclusion (OR [95% IC]: 1.20 [1.00–1.45] per 103 mmHg·min; P = 0.047), and at day 1, a decrease in cardiac index (1.30 [1.08–1.56] per 0.5 L/min/m2; P = 0.007) or cardiac power index (1.84 [1.18–2.87] per 0.1 W/m2, P = 0.008). Conclusion. In the first 24 hours, parameters related to cardiac reserve, such as double product and cardiac index evolution, provide crucial and easy to achieve hemodynamic physiological information, which may impact the outcome.

Utility of Cardiac Power Hemodynamic Measurements in the Evaluation and Risk Stratification of Cardiovascular Conditions

“…Detailed journal article demographics, outcomes, and disease state definitions of the condition examined are highlighted in Table 3 . In the final analysis, 41 studies [ 3 , 6 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ] were included covering a total of 33,906 patients. When determining the use of CP in the determination of prognosis throughout the various disease processes, we categorized the articles based on the disease process they were associated with, as shown in Table 1 .…”

“…This group contained three articles, where all three articles compared CPI between survivors and non-survivors and had slightly different definitions of septic shock, shown in Table 3 . One study showed a very strong significance ( p < 0.0001) with a population size of 39 [ 23 ]; another showed just under statistical significance between groups with p = 0.058 with a population size of 70 [ 17 ]; and the third article, which had a population size of 141, showed no statistical significance with p > 0.05 [ 18 ]. One article also tested the significance of CPO in determining mortality in septic shock and compared ICU survivors and non-survivors with a significant finding of p < 0.0001 [ 23 ].…”

“…Specifically, resting CP is easily measured without having to subject patients to additional invasive procedures, which could lead to further decompensation in their condition. CP has been shown to be a powerful predictor of mortality in cardiogenic shock [ 6 , 11 , 12 , 13 , 14 ], chronic heart failure [ 15 , 16 ] and sepsis [ 17 , 18 ], among other conditions. Despite showing prognostic utility across a wide range of conditions, however, it is not routinely used to guide treatment of cardiac or critically ill patients.…”

Personalized physiological medicine

“…For instance, the dobutamine challenge test to evaluate the regulatory capacity of the β-adrenergic system in septic patients was introduced by Vallet and co-workers, who were able to predict survival in septic patients by measuring the response to oxygen delivery, consumption, and extraction [ 20 ]. A nonpharmacological version of the dobutamine stress test was explored by Kimmoun et al to assess the efficiency of cardiac adaptation to septic shock by measuring cardiac contractility reserve-related parameters, including cardiac index, double product, and cardiac power index during the resuscitation procedure [ 21 ]. In this context, the heart rate response is also a promising methodology to assess the ability of the autonomic nervous system to regulate cardiovascular responses and assess interorgan communication [ 22 , 23 ].…”

Judging quality of current septic shock definitions and criteria

“…Septic shock, the most severe form of sepsis, is highly complex, with concurrent myocardial, vascular (macro- and micro-), tissue perfusion and cellular level abnormalities. Myocardial abnormalities include both cardiomyocyte injury [ 4 ] and structural myocardial dysfunction [ 6 , 7 ]. Vascular abnormalities affect the endothelium, sub-endothelial tissues, microcirculation and vasomotor tone.…”