The effect of dobutamine stress echocardiography on tissue Doppler imaging values as a predictor of mortality in patients with septic shock

AbstractObjectiveRecently, dobutamine stress echocardiography [DSE] has been used to study the cardiovascular response in patients with septic shock. The increase in stroke volume index after DSE was seen to be strongly correlated to survival. However, its effect on the tissue Doppler imaging [TDI] values in patients with septic shock was not well established. In this study we investigated the effect of DSE on TDI values as a predictor of norepinephrine weaning and mortality in patients with septic shock.DesignA prospective interventional study was carried out.PatientsA total of 69 adult patients with septic shock were included.InterventionGraded dobutamine infusion with gradual elevation of the dose from 5 to 15 μg/kg/min at 15-min intervals. Variables of interestThe TDI values before and after graded dobutamine challenge.ResultsDuring the period of 14 months, 69 adult septic shock patients were enrolled in the study, of which 18 [26.1%] survived stay in the Intensive Care Unit (ICU), while 51 [73.9%] did not. The main result of interest was the mitral annular TDI systolic wave ( s′). At rest, the s′ wave was significantly lower in survivors [8 ± 2 vs 12 ± 4 cm/s; p< 0.001]. After dobutamine, both groups showed an increase in s′ with no significant difference between the 2 groups [13 ± 3 vs 15 ± 2 cm/s; p= 0.07]. The stress–rest difference was significantly higher in survivors [7 ± 2 vs 1 ± 3 cm/s], with a receiver operator characteristic [ROC] curve of the stress–rest change showing a cutoff value of >4 cm/s to be associated with better survival of ICU stay, with an area under the curve [AUC] of 0.939 [95% confidence of interval [95% CI] = 0.871–0.999]. A cutoff value of 2 cm/s was associated with better norepinephrine weaning, with an AUC of 0.985 [95% CI = 0.961–1]. ConclusionsVariations in TDI after DSE were able to predict survival in septic shock patients, with an s′ wave stress–rest change of >4 cm/s being associated to lower ICU mortality, while a cutoff value >2 cm/s was associated to better norepinephrine weaning.