1559: EFFECT OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY ON TISSUE DOPPLER IMAGING VALUES IN SEPTIC SHOCK

Abstract

Learning Objectives: Recently Dobutamine Stress Echocardiography (DSE) was used to study the cardiovascular response in patients with septic shock. It was found that the increase in the stroke Volume Index after Dobutamine stress testing most strongly correlated with survival. However, it’s effect on the Tissue Doppler Imaging (TDI) values in patients with septic shock and it’s ability to predict the mortality was not well established. Methods: This prospective non-randomized interventional study was conducted on adult mechanically ventilated patients admitted to the intensive care unit (ICU) within 24 hours from the diagnosis of septic shock and receiving Nor-epinephrine. Echocardiographic data including TDI values were recorded at baseline and after the start of graded Dobutamine infusion with gradual increasing of the dose from 5 μg/Kg/min to 15 μg/kg/min with 15 minutes intervals. TDI values were obtained by placing the pulsed wave TDI at lateral and septal mitral annulus on apical four chamber view and the average value was obtained. All the patients were followed for 28 days to determine ICU mortality, 28 days mortality and weaning of Nor-epinephrine. Patients were divided into survivors who survived the ICU stay and those who did not (nonsurvivors). Results: A total of 69 adult septic shock patients were included in the study, of which 18(26.1%) survived the ICU stay while 51(73.9%) didn’t. At rest, S’ wave was significantly lower in survivors (8 ± 2 vs 12 ± 4 cm/s, P<0.001). After Dobutamine, there was no significant difference between the 2 groups (13 ± 3 vs 15 ± 2 cm/ sec, P=0.07). The stress-rest difference was significantly higher in survivors (7 ± 2 vs 1 ± 3 cm/s). there was no significant difference as regards the e’, a’ and E/e’ ratio. A ROC curve of the stress-rest change showed that a cutoff value of >4 cm/s was associated with better survival of the ICU stay with AUC of 0.939 (95%CI=0.8711), sensitivity of 88.2% specificity of 88.9%, PPV of 95.7%, and NPV of 72.7%. Patients with stress-rest S’> 4 cm/s compared to those with ≤4 cm/s showed lower ICU and 28 days mortality (27.7% vs 95.7%, P<0.001), better weaning of Nor-epinephrine (100% vs 19.1%, P<0.001), and lower Nor-epinephrine dose (13.77 ± 3.15 vs 20.15 ± 6.48 μg/min P<0.001) Conclusions: TDI changes after DSE were able to predict survival in septic shock patients with S’ wave stress-rest change of > 4 cm/s was associated with lower ICU mortality, 28 days mortality, better weaning of Nor-epinephrine and lower Nor-epinephrine dose