Journal of American Science, 2011;7(12) http://www.americanscience.org http://www.americanscience.org editor@americanscience.org 47 Septic Cardiomyopathy: Role of Echocardiography and Brain Natriuretic Peptide Hassan Abu-Khabar 1 , Mohammed Moustafa Abdel Salam Megahed 1 and Ashraf Essam Roshdy 1 1 Department of Critical Care Medicine, Faculty of Medicine, University of Alexandria, Egypt. ashrafroshdy76@hotmail.com Abstract: Introduction: Myocardial dysfunction occurs in about 40% of patients presenting with sepsis and septic shock. The most important hypothesis to explain it is based on a circulating myocardial depressant substance. Hypothesis: To evaluate the possibility of early diagnosis of myocardial dysfunction in patients in sepsis or septic shock using the transthoracic echocardiography or the brain Natriuretic peptide (BNP). Methods: 46 patients presented with severe sepsis or septic shock according to the criteria of the 2001 SCCM/ESICM/ACCP/ATS/SIS sepsis definition were included in the study. The patients undergone serial transthoracic Echocardiographic examinations, Sequential Organ Failure Assessment (SOFA score) and BNP measurements on admission to the ICU and till death or discharge. The patients were retrospectively divided into survivors and non survivors for statistical analysis of the sensitivity and specificity of the Echocardiographic data and the BNP in correlation to the SOFA score and the prognosis. Results: The mortality of patients with systolic left ventricular failure (LVEF < 55%) was 82.4%, in contrast to 51.7% in patients with normal systolic function. (p=0.037) Patients who had diastolic dysfunction on admission represented 39.1%. In the non survivors group 44.8% of them had diastolic dysfunction in comparison to 29.4% in the survivor group. The BNP in the survivor group ranged from 345.01±222.10 pg/ml on admission and increased till it reached a mean of 406.2±295.39 pg/ml at day 3 before decreasing to 163.69±134.39 pg/ml at discharge. The non-survivors had a higher mean which ranged from 708.62±305.17 pg/ml on admission to 1022.11±363.41 pg/ml at the third day. The BNP had a significant correlation with both the SOFA score (p=0.037) and delta SOFA score (p=0,025). A BNP level of 250.5 has a sensitivity of 82.8% and a specificity of 64.7% in predicting the mortality of patients in our study. Conclusion: BNP is sensitive but not specific for the diagnosis of heart failure and is correlated to the prognosis and SOFA score in patients admitted to the ICU with severe sepsis and septic shock. A cut off value of 250 pg/ml has a sensitivity of 82.8% and specificity of 64.7% in detecting the mortality of such patients. [Hassan Abu-Khabar, Mohammed Moustafa Abdel Salam Megahed and Ashraf Essam Roshdy. Septic Cardiomyopathy: Role of Echocardiography and Brain Natriuretic Peptide. Journal of American Science 2011; 7(12):47-62]. (ISSN: 1545-1003). http://www.americanscience.org. 7 Keywords: sepsis; shock; critical care; BNP; echocardiography. 1. Introduction Sepsis is defined as “the systemic inflammatory response syndrome (SIRS) that occurs during infection”. (1) Sepsis is estimated to account for 1% of all hospital admissions in the U.S.A. (1) The total national hospital cost invoked by severe sepsis in the U.S.A. was estimated at approximately $16.7 billion on the basis of an estimated severe sepsis rate of 751 000 cases per year with 215 000 associated deaths annually. (2) The cardiovascular system and its dysfunction during sepsis have been studied for more than 5 decades. In 1951, Waisbren described cardiovascular dysfunction due to sepsis for the first time. (3) As early as the 1980s, significant reductions in both stroke volume and ejection fraction in septic patients were described despite normal total cardiac output. (4) Importantly, the presence of cardiovascular dysfunction in sepsis is associated with a significantly increased mortality rate of 70% to 90% compared with 20% in septic patients without such cardiovascular impairment. (5) In studies of septic shock lasting ≥ 48 hours, 24% to 44% had systolic LV dysfunction (6-8) while 44% showed features of diastolic dysfunction. (7) Myocardial depression is a reversible phenomenon that subsided in 7–10 days if the patient survived. (9) The characteristics of myocardial depression in septic shock are reduced ventricular ejection fraction and biventricular dilatation, although the marked dilatation has not been confirmed in some studies. (7,10,11) Diastolic dysfunction is not as clearly defined. (9) Poelart et al. (7) demonstrated that cardiac dysfunction in septic shock is a continuum from isolated diastolic dysfunction to both diastolic and systolic ventricular failure. The impact of septic myocardial dysfunction on the outcome has been controversial. Some studies have found an initially lower LVEF and more dilated LV in patients who survived, (4,11) while some have noticed decreased cardiac function in non- survivors. (7,12) Different mechanisms in evaluation of