The Effect of a Hyperdynamic Circulation on Tissue Doppler Values: A Simulation in Young Adults during Exercise

Royse, Colin; Rui-zhi, NI; Huynh, Andrew; Royse, Alistair

doi:10.1155/2011/165874

Cited by 1 publication

(1 citation statement)

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“…In healthy hyperdynamic hearts (i.e. during exercise), both systolic function (estimated by the s′ wave on tissue Doppler) and the myocardial relaxation velocity (e′) increase with demand [ 20 ]. A similar relationship was seen in our hypothesis-generating series of patients with severe sepsis and septic shock if they had normal systolic and diastolic function (based on the current ASE/EACI guidelines) on day 1 (see Fig.…”

Section: Discussionmentioning

confidence: 99%

Detecting impaired myocardial relaxation in sepsis with a novel tissue Doppler parameter (septal e′/s′)

Clancy¹,

Slama²,

Huang³

et al. 2017

Crit Care

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BackgroundLeft ventricular diastolic dysfunction is associated with mortality outcomes in severe sepsis and septic shock. There are ongoing issues with diagnosing diastolic dysfunction in this cohort, partly owing to the poor applicability of traditional parameters in the hyperdynamic circulation. In this feasibility study, we sought to assess the utility of a novel parameter (septal e′/s′) to identify diastolic dysfunction in patients with severe sepsis and septic shock who had normal systolic function against the 2016 American Society Echocardiography and European Association of Cardiovascular Imaging (ASE/EACI) guidelines on diastolic dysfunction.MethodsIn this prospective observational pilot study, patients identified as having severe sepsis and septic shock underwent transthoracic echocardiography on day 1 and day 3 of their intensive care unit admission. In patients with normal systolic function, septal e′/s′ was calculated using the peak modal velocity of the s′ compared with the e′ from the septal annulus tissue Doppler imaging and compared with their diastolic grade according to the 2016 ASE/EACI guidelines on diastolic dysfunction.ResultsOn day 1 of admission, 44 of 62 patients with severe sepsis and septic shock had normal systolic function. There was a strong association of those with diastolic dysfunction having a reduced septal e′/s′ compared with patients with normal diastolic function (AUC 0.91). A similar relationship was seen with patients who had indeterminate diastolic dysfunction. On day 3, 37 patients had normal systolic function. Again, there was a strong association of those with diastolic dysfunction and a reduced septal e′/s′ (AUC 0.95).ConclusionsA reduction in septal e′/s′ may indicate diastolic dysfunction in patients with severe sepsis and septic shock who have normal systolic function. As opposed to limited traditional measures of diastolic dysfunction, it is applicable in those with hyperdynamic systolic function.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1727-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%