Early dynamic left intraventricular obstruction is associated with hypovolemia and high mortality in septic shock patients

Jean-Louis Chauvet, Shari El-Dash, Olivier Delastre, Bernard Bouffandeau, Dominique Jusserand, Jean-Baptiste Michot, Fabrice Bauer, Julien Maizel, Michel Slama

Based on previously published case reports demonstrating dynamic left intraventricular obstruction (IVO) triggered by hypovolemia or catecholamines, this study aimed to establish: (1) its occurrence in septic-shock patients; (2) correlation between this intraventricular gradient (IVG) with volume status and fluid responsiveness; (3) mortality rate. We prospectively analyzed patients with septic shock admitted to a general ICU over a 28 month period who presented Doppler signs of IVO. Clinical characteristics and hemodynamic parameters as well as echocardiographic data regarding left ventricular function, size, and calculated mass, as well as left-ventricular outflow Doppler pattern and velocity before and after fluid infusions were recorded. 218 patients with septic shock were admitted in our ICU during the study period. IVO was observed in 47 (22 %) patients. Mortality rate at 28 days was found to be higher in patients with than in patients without IVO (55 % vs 33 % p < 0.01). Small, hypercontractile left ventricles, (end-diastolic LV surface 4.7 ± 2.1 cm(2)/m(2) and ejection fraction 82 ± 12 %), and frequently pseudohypertrophic were found in these patients. A rise of ≥ 12 % in stroke index was found in 87 % patients with IVO with drop of 47 % of intra ventricular obstruction after fluid infusion. Left intraventricular obstruction is a frequent event in septic shock patients bearing an important correlation with fluid-responsiveness. Mortality rate was found to be higher in these patients in comparison with patients without obstruction.