Sepsis-induced cardiomyopathy in animals: From experimental studies to echocardiography-based clinical research.

The term "sepsis-induced cardiomyopathy" (SIC) is used to describe transient cardiac dysfunction in septic patients. However, there is no universally accepted definition of SIC; a reduction in left ventricular ejection fraction (LVEF) is often used. In addition to systolic dysfunction, diastolic dysfunction is now recognized as an essential component of SIC. It can be emphasized that previous animal experiments played an essential role in revealing SIC and hemodynamic instability in sepsis and septic shock. The diagnostic and prognostic capabilities of echocardiography for the assessment of SIC have been extensively studied since its introduction into intensive care clinical practice. Recent studies in dogs, calves, and horses have shown that left and right ventricular systolic dysfunction, left ventricular diastolic dysfunction, and circulatory dysfunction can occur in sepsis, severe sepsis, and septic shock in animals. Echocardiographic variables have also shown that indices of left and right ventricular dysfunction and circulatory failure are valuable indicators of mortality in septic animals.

Cardiomyopathie induite par la septicémie chez l'animal : des études expérimentales à la recherche clinique basée sur l'échocardiographie. Le terme « cardiomyopathie induite par la septicémie ¼ (SIC) est utilisé pour décrire un dysfonctionnement cardiaque transitoire chez les patients septiques. Cependant, il n'y a pas de définition universellement acceptée du SIC; une réduction de la fraction d'éjection ventriculaire gauche (FEVG) est souvent utilisée. En plus de la dysfonction systolique, la dysfonction diastolique est maintenant reconnue comme une composante essentielle du SIC. On peut souligner que les expérimentations animales antérieures ont joué un rôle essentiel dans la révélation du SIC et de l'instabilité hémodynamique dans la septicémie et le choc septique. Les capacités diagnostiques et pronostiques de l'échocardiographie pour l'évaluation du SIC ont été largement étudiées depuis son introduction dans la pratique clinique des soins intensifs. Des études récentes sur des chiens, des veaux et des chevaux ont révélé qu'un dysfonctionnement systolique ventriculaire gauche et droit, un dysfonctionnement diastolique ventriculaire gauche et un dysfonctionnement circulatoire peuvent survenir dans la septicémie, la septicémie sévère et le choc septique chez les animaux. Les variables échocardiographiques ont également démontré que les indices de dysfonctionnement ventriculaire gauche et droit et d'insuffisance circulatoire sont des indicateurs précieux de la mortalité chez les animaux septiques.(Traduit par Dr Serge Messier).

Echocardiographic Assessment of Left Ventricular Systolic and Diastolic Functions in Dogs with Severe Sepsis and Septic Shock; Longitudinal Study.

The purpose of this study was to monitor left ventricular systolic dysfunction (LVSD) and diastolic dysfunction (LVDD) using transthoracic echocardiography (TTE) in dogs with severe sepsis and septic shock (SS/SS). A prospective longitudinal study using 23 dogs with SS/SS (experimental group) and 20 healthy dogs (control group) were carried out. All the clinical, laboratory and cardiologic examinations for the experimental dogs were performed at admission, 6 and 24 h after the start of treatment and on the day of discharge. LVSD was described as LV ejection fraction (LVEF) < 50%. LVDD was determined when the septal mitral annulus early diastolic velocity (LVEm) was <8 cm/s. LVSD and LVDD were present in 3 and 16 dogs with SS/SS, respectively, with both types of dysfunction present in 2 of the dogs. Although all the dogs with LVSD survived, 8 dogs with LVDD did not. The survival period was significantly shorter in dogs with an LVEm < 8 cm/s (1.3 ± 1.4 days). In conclusion, LVDD, rather than LVSD, was a common cardiovascular abnormality in the septic dogs, and this may be a negative prognostic factor. TTE is a useful tool for the identifying and monitoring of myocardial dysfunction in the dogs with SS/SS.

Pleuroperitoneal true diaphragmatic hernia of the liver in a cat.

A 2-year old female domestic shorthair cat was referred with intermittent vomiting. Laboratory analyses revealed only an elevated alanine aminotransferase activity. Plain thoracic radiographs showed a right-sided transdiaphragm protrusion of a liver lobe into the thoracic cavity. On abdominal ultrasound the diaphragm and liver parenchyma also presented a bulge towards the thoracic cavity. By cranial median laparotomy herniation of the quadrate liver lobe through the right aspect of the diaphragm into the thoracic cavity was confirmed. The protruding quadrate liver lobe was covered by intact parietal peritoneum. Following relocation of the liver lobe the defect was closed. Postoperatively the intermittent vomiting stopped. The purpose of this case report was to present plain radiography and abdominal ultrasonography as effective tools in the diagnosis of this rare and usually asymptomatic true herniation case along with its operative treatment.

Prognostic importance of tissue Doppler imaging of systolic and diastolic functions in dogs with severe sepsis and septic shock.

The goal of this study was to determine the distribution of left ventricular (LV) systolic and diastolic dysfunctions and their prognostic value in canine parvovirus-infected dogs suffering from severe sepsis and septic shock (SS/SS). Twenty dogs with SS/SS (experimental group) and 18 healthy dogs (control group) were used in the study. Systolic and diastolic dysfunction was present in three (15%) and 14 (70%) diseased dogs, respectively, with both types of dysfunction present in two (10%) of the patients. These dogs were split into two groups: survivors (Sv, n = 14) and non-survivors (non-Sv, n = 6). The pulsed wave tissue Doppler (PW-TDI) septal mitral annulus systolic velocity (LVS'), an index of systolic dysfunction, had a high sensitivity and specificity to differentiate Sv and non-Sv animals, with values of 83.3% (95% CI: 41.6-98.4) and 83.3% (95% CI: 59.8-94.8), respectively, at an optimum cut-off point of ≥ 9.90. The PW-TDI septal early mitral annulus early-diastolic peak velocity (E'), an index of diastolic dysfunction, had the best sensitivity and specificity to differentiate Sv and non-Sv dogs, with values of 100% (95% CI: 55.2-100) and 100% (95% CI: 78.9-100), respectively, at an optimum cut-off point of ≤ 6.50. Therefore, diastolic dysfunction determined by E' is a good independent outcome predictor.

Echocardiographic assessment of left ventricular systolic function in neonatal calves with naturally occurring sepsis or septic shock due to diarrhea.

Sepsis is associated with clinically relevant cardiovascular changes. The objectives of this study were to evaluate the clinical value of echocardiography for monitoring left ventricular (LV) systolic function in septic calves. A prospective longitudinal study was performed using a convenience sample. Twenty septic calves and 10 healthy calves were enrolled in the study. Arterial blood pressure (BP) was measured and M-mode echocardiography performed to characterize LV systolic function; the latter included measurement of ejection fraction, EF; stroke volume, SVI and cardiac output indexed to body weight, CI; E-point of septal separation, EPSS; pre-ejection period, PEP; ejection time, LVET; ratio of PEP to LVET; velocity of circumferential shortening, Vcf, LV end-diastolic volume index (LVEDVI) and LV end-systolic volume index (LVESVI) on admission and 6, 24, 48 and 72 h later in septic calves and once in healthy calves. Admission data were compared using the Mann-Whitney U test and P < .05 was considered significant. Decreased preload and afterload were present in septic calves, as indicated by marked decreases in BP, LVEDVI, LVESVI, SVI, CI, EPSS when compared to healthy calves. Systolic function appeared adequate in septic calves, based on EF and FS compared to control calves. There was no difference in heart rate, LVET, PEP:LVET, or Vcf between septic and health calves. We conclude that circulatory dysfunction, rather than systolic dysfunction predominates in septic calves. Positive associations on admission between CI and LVEDVI, LVESVI, and SVI support this conclusion. Echocardiographic determination of LVEDVI and CI appears useful in directing treatment in septic calves.