Stroke volume change after digoxin loading in septic shock patients with transient left ventricular systolic dysfunction.

Abstract

Transient left ventricular (LV) systolic dysfunction is a challenging complication of septic shock. Although Levosimendan, a calcium sensitizer has been reported to have a therapeutic role, digoxin, which increases intra-myocardial calcium level and cardiac contractility has no available data even though digoxin has abundant clinical experience. We retrospectively reviewed medical records of septic shock patients who developed transient LV systolic dysfunction and were treated with loading dose of digoxin between 01 Oct 2016 and 31 Dec 2017. Digoxin loading was given to 18 septic shock patients with mechanical ventilator and high dose vasopressors. Echocardiographic assessment was available in 6 patients. Mean age was 65.0 ± 10.2 years and 4 patients (66.7%) were female. Coronary angiography was performed in 2 patients with no lesion (33.3%). Four patients exhibited typical regional wall motion abnormality of Takotsubo syndrome (TS) and 1 patient reversed type of TS and 1 patient global hypokinesia. Bedside echocardiography revealed increased stroke volume after loading dose of digoxin. Detailed echocardiographic strokevolume measurement beforeand after digoxin loading are shown in table 1. In conclusion, in septic shock patients with transient LV dysfunction such as TS, digoxin loading can be a feasible treatment. Further clinical study is needed.