Practical approach to diastolic dysfunction in light of the new guidelines and clinical applications in the operating room and in the intensive care

Abstract

There is growing evidence both in the perioperative period and in the field of intensive care (ICU) on the association between left ventricular diastolic dysfunction (LVDD) and worse outcomes in patients. The recent American Society of Echocardiography and European Association of Cardiovascular Imaging joint recommendations have tried to simplify the diagnosis and the grading of LVDD. However, both an often unknown pre-morbid LV diastolic function and the presence of several confounders—i.e., use of vasopressors, positive pressure ventilation, volume loading—make the proposed parameters difficult to interpret, especially in the ICU. Among the proposed parameters for diagnosis and grading of LVDD, the two tissue Doppler imaging-derived variables e′ and E/e′ seem most reliable. However, these are not devoid of limitations. In the present review, we aim at rationalizing the applicability of the recent recommendations to the perioperative and ICU areas, discussing the clinical meaning and echocardiographic findings of different grades of LVDD, describing the impact of LVDD on patients’ outcomes and providing some hints on the management of patients with LVDD.

A decade of progress in critical care echocardiography: a narrative review

“…Basic cardiac and lung ultrasonography can be used to accurately diagnose acute decompensated heart failure and the combination outperforms traditional tools such as physical examination, chest X-ray and laboratory studies [37][38][39]. Advanced CCE may be used to provide an evaluation of LV diastolic function, which no other hemodynamic monitoring tool can provide [40,41]. There is increasing recognition that LV diastolic dysfunction is associated with higher mortality in patients with septic shock, and a greater incidence of failed weaning from ventilatory support.…”

Transthoracic Echocardiography in Prone Patients With Acute Respiratory Distress Syndrome: A Feasibility Study

“…TTE is an alternative tool that is noninvasive, poses very little risk to the patient, and can provide direct information regarding RV and LV function to make clinical decisions ( 18 ). For example, failure to wean from mechanical ventilation may be cardiac rather than respiratory in etiology, and LV diastolic dysfunction and volume status can be readily assessed and optimized by echocardiography to facilitate weaning from mechanical ventilation ( 2 ). Table 2 describes several indications for performing TTE in the management of critically ill patients with ARDS.…”

“…It is often used to guide management by assessing response to interventions or to perform serial monitoring. Focused TTE assessment in ARDS patients may offer clinical benefits from hemodynamic monitoring and optimization of cardiac function and volume status to facilitate weaning from mechanical ventilation ( 1 , 2 ). Prone positioning, while demonstrated to increase oxygenation and reduce mortality in ARDS ( 1 ), has previously precluded TTE examinations due to the perception that transthoracic windows cannot be obtained in the prone position.…”

Correction to: Practical approach to diastolic dysfunction in light of the new guidelines and clinical applications in the operating room and in the intensive care

“…In the original article [ 1 ], the authors noticed a typographical error in Figure 2. The top left box should have included “E/A <0.8 and E <50 cm/s”.…”