Application of a simplified definition of diastolic function in severe sepsis and septic shock

Abstract

BackgroundLeft ventricular diastolic dysfunction is common in patients with severe sepsis or septic shock, but the best approach to categorization is unknown. We assessed the association of common measures of diastolic function with clinical outcomes and tested the utility of a simplified definition of diastolic dysfunction against the American Society of Echocardiography (ASE) 2009 definition.MethodsIn this prospective observational study, patients with severe sepsis or septic shock underwent transthoracic echocardiography within 24 h of onset of sepsis (median 4.3 h). We measured echocardiographic parameters of diastolic function and used random forest analysis to assess their association with clinical outcomes (28-day mortality and ICU-free days to day 28) and thereby suggest a simplified definition. We then compared patients categorized by the ASE 2009 definition and our simplified definition.ResultsWe studied 167 patients. The ASE 2009 definition categorized only 35 % of patients. Random forest analysis demonstrated that the left atrial volume index and deceleration time, central to the ASE 2009 definition, were not associated with clinical outcomes. Our simplified definition used only e′ and E/e′, omitting the other measurements. The simplified definition categorized 87 % of patients. Patients categorized by either ASE 2009 or our novel definition had similar clinical outcomes. In both definitions, worsened diastolic function was associated with increased prevalence of ischemic heart disease, diabetes, and hypertension.ConclusionsA novel, simplified definition of diastolic dysfunction categorized more patients with sepsis than ASE 2009 definition. Patients categorized according to the simplified definition did not differ from patients categorized according to the ASE 2009 definition in respect to clinical outcome or comorbidities.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1421-3) contains supplementary material, which is available to authorized users.

Prognostic impact of isolated right ventricular dysfunction in sepsis and septic shock: an 8-year historical cohort study

“…Hence, combined biventricular dysfunction might be a benign adaptive response in sepsis, whereas isolated RV dysfunction could reflect the inability of the RV to respond appropriately to stress and physiological demand [ 27 ]. Furthermore, the definitions of LV systolic dysfunction and diastolic dysfunction need further validation in the sepsis population that could influence clinical outcomes [ 2 , 28 ].…”

Pearls and pitfalls in comprehensive critical care echocardiography

“…In ICU patients, evaluation of both diastolic function and left atrial pressure should be interpreted separately. The e’ is potentially the best parameter in ICU patients to assess left ventricular relaxation due to its lesser dependence on the preload [ 28 ], although relying on this one parameter alone is likely to be misleading in a great range of pathologies. When using TDI it is important to to ensure accurate imaging: for example by placing the PW Doppler trace at the mitral annulus base and considering that the measurement is angle-dependent.…”

Utility of tissue Doppler imaging of systolic function to diagnose diastolic dysfunction in critically ill patients

“…But why is there so much interest in diastolic dysfunction in the ICU population? We think it might be influenced by studies identifying diastolic dysfunction as a predictor of mortality especially in the septic population [1,2,4,[6][7][8]. The 2016 ASE/EACVI guidelines simplify our approach to diastolic dysfunction but they do not solve all diagnostic problems in critically ill and mechanically ventilated patients.…”