A simplified definition of diastolic function in sepsis, compared against standard definitions

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Michael J Lanspa1,2, Troy D Olsen1, Emily L Wilson1

  • 11Critical Care Echocardiography Service, Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT 84157 USA.

Journal of Intensive Care
|March 2, 2019
PubMed

Insights

A simplified echocardiogram definition better categorizes diastolic dysfunction in septic patients compared to American Society of Echocardiography (ASE) guidelines. This simplified method shows clearer associations with comorbidities, unlike ASE 2016 which misclassifies some patients with elevated left ventricular filling pressures.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Echocardiography

Background:

  • Current guidelines for grading diastolic dysfunction have limitations in categorizing septic patients.
  • The American Society of Echocardiography (ASE) 2009 and 2016 definitions are compared for their efficacy in septic populations.
  • Septic patients often present complex cardiac profiles requiring refined diagnostic approaches.

Purpose of the Study:

  • To compare the categorization performance of ASE 2009, ASE 2016, and a simplified diastolic dysfunction definition in septic patients.
  • To assess the association between diastolic dysfunction grading, comorbidities, and 28-day all-cause mortality.
  • To identify a more effective method for evaluating diastolic function in critically ill septic individuals.

Main Methods:

  • Retrospective analysis of 398 septic patients undergoing transthoracic echocardiography within 24 hours of ICU admission.
  • Categorization of diastolic function using ASE 2009, ASE 2016, and a simplified definition based on E/e' ratio.
  • Logistic regression analysis to determine associations between diastolic grade, comorbidities (diabetes, hypertension, myocardial infarction), and mortality.

Main Results:

  • A simplified definition categorized a higher proportion of patients (78%) compared to ASE 2016 (71%) and ASE 2009 (34%).
  • Higher diastolic dysfunction grades correlated with hypertension, myocardial infarction, and diabetes, particularly with the simplified definition.
  • Diastolic dysfunction grade did not significantly associate with 28-day mortality; ASE 2016 misclassified 40% of patients with elevated E/e' as normal.

Conclusions:

  • The ASE 2016 definition improves categorization over ASE 2009 but still leaves a significant portion of septic patients unclassified.
  • A simplified definition using E/e' offers less ambiguous categorization and demonstrates associations with key comorbidities in septic patients.
  • Current echocardiographic guidelines may underestimate diastolic dysfunction in sepsis, highlighting the need for refined assessment tools.
Abstract

Keywords:
Diastolic dysfunctionEchocardiographyPreloadSeptic cardiomyopathy

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