ORIGINAL ARTICLE
Utility of tissue Doppler imaging of systolic function to diagnose diastolic dysfunction in critically ill patients
1
Anaesthesiology and Intensive Care, District Hospital in Oława, Poland
2
Department of Anaesthesiology and Intensive Care, 4th Military Hospital of Wrocław, Poland
3
Department of Mathematics, Faculty of Environmental Engineering and Geodesy, Wroclaw University of Environmental and Life Sciences, Poland
4
Anaesthesiology and Intensive Care, District Hospital in Rawicz, Poland
Publication date: 2019-08-23
Anaesthesiol Intensive Ther 2019;51(4):268-272
KEYWORDS
ABSTRACT
Background:
Diastolic dysfunction might be associated with increased mortality in severe sepsis and septic shock. In 2016 new American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines were published. They simplify our approach to diastolic dysfunction recognition, but they were not validated in critical care settings. The aim of the study was to assess the applicability of systolic tissue Doppler imaging of left ventricle in patients with and without diastolic dysfunction classified on the basis of the new guidelines.
Methods:
Two echocardiographers analyzed transthoracic echocardiography (TTE) examinations and assigned patients according to ASE/EASCVI guidelines to three groups: patients with systolic dysfunction and diastolic dysfunction, patients with normal systolic function and diastolic dysfunction, and patients with normal systolic and diastolic function.
Results:
We performed 593 examinations in 320 patients and 390 examinations in 200 patients were included in the study. In 264 examinations with ejection fraction (EF) < 55% systolic and diastolic dysfunction was diagnosed (group 1). In 114 examinations with EF ≥ 55% normal systolic and diastolic function was diagnosed (group 2). In 12 examinations with EF ≥ 55% normal systolic and abnormal diastolic dysfunction was diagnosed (group 3). After analyzing mean systolic tissue Doppler of the mitral annulus we found a statistically significant difference between group 1 and 2 (P < 0.0001) and between group 2 and 3 (P < 0.0001). The difference in values of means in group 1 vs. 3 was not statistically significant (P = 0.853).
Conclusion:
Systolic tissue Doppler analysis of mitral annulus might help to diagnose diastolic dysfunction especially in patients with preserved ejection fraction.
Diastolic dysfunction might be associated with increased mortality in severe sepsis and septic shock. In 2016 new American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines were published. They simplify our approach to diastolic dysfunction recognition, but they were not validated in critical care settings. The aim of the study was to assess the applicability of systolic tissue Doppler imaging of left ventricle in patients with and without diastolic dysfunction classified on the basis of the new guidelines.
Methods:
Two echocardiographers analyzed transthoracic echocardiography (TTE) examinations and assigned patients according to ASE/EASCVI guidelines to three groups: patients with systolic dysfunction and diastolic dysfunction, patients with normal systolic function and diastolic dysfunction, and patients with normal systolic and diastolic function.
Results:
We performed 593 examinations in 320 patients and 390 examinations in 200 patients were included in the study. In 264 examinations with ejection fraction (EF) < 55% systolic and diastolic dysfunction was diagnosed (group 1). In 114 examinations with EF ≥ 55% normal systolic and diastolic function was diagnosed (group 2). In 12 examinations with EF ≥ 55% normal systolic and abnormal diastolic dysfunction was diagnosed (group 3). After analyzing mean systolic tissue Doppler of the mitral annulus we found a statistically significant difference between group 1 and 2 (P < 0.0001) and between group 2 and 3 (P < 0.0001). The difference in values of means in group 1 vs. 3 was not statistically significant (P = 0.853).
Conclusion:
Systolic tissue Doppler analysis of mitral annulus might help to diagnose diastolic dysfunction especially in patients with preserved ejection fraction.
REFERENCES (26)
1.
Sanfilippo F, Corredor C, Fletcher N, et al. Diastolic dysfunction and mortality in septic patients: a systematic review and meta-analysis. Intensive Care Med 2015; 41: 1004-1013. doi: 10.1007/s00134-015-3748-7.
2.
Gonzalez C, Begot E, Dalmay F, et al. Prognostic impact of left ventricular diastolic function in patients with septic shock. Ann Intensive Care 2016; 6: 36. doi: 10.1186/s13613-016-0136-6.
3.
Roche-Campo F, Bedet A, Vivier E, Brochard L, Mekontso Dessap A. Cardiac function during weaning failure: the role of diastolic dysfunction. Ann Intensive Care 2018; 8: 2. doi: 10.1186/s13613-017-0348-4.
4.
Lanspa MJ, Gutsche AR, Wilson EL, et al. Application of a simplified definition of diastolic function in severe sepsis and septic shock. Crit Care 2016; 20: 243. doi: 10.1186/s13054-016-1421-3.
5.
Brown SM, Pittman JE, Hirshberg EL, et al. Diastolic dysfunction and mortality in early severe sepsis and septic shock: a prospective, observational echocardiography study. Crit Ultrasound J 2012; 4: 8. doi: 10.1186/2036-7902-4-8.
6.
Landesberg G, Jaffe AS, Gilon D, et al. Troponin elevation in severe sepsis and septic shock: the role of left ventricular diastolic dysfunction and right ventricular dilatation. Crit Care Med 2014; 42: 790-800. doi: 10.1097/CCM.0000000000000107.
7.
Landesberg G, Gilon D, Meroz Y, et al. Diastolic dysfunction and mortality in severe sepsis and septic shock. Eur Heart J 2012; 33: 895-903. doi: 10.1093/eurheartj/ehr351.
8.
Sturgess DJ, Marwick TH, Joyce C, et al. Prediction of hospital outcome in septic shock: a prospective comparison of tissue Doppler and cardiac biomarkers. Crit Care 2010; 14: R44. doi: 10.1186/cc8931.
9.
Bouhemad B, Nicolas-Robin A, Arbelot C, Arthaud M, Féger F, Rouby JJ. Isolated and reversible impairment of ventricular relaxation in patients with septic shock. Crit Care Med 2008; 36: 766-774. doi: 10.1097/CCM.0B013E31816596BC.
10.
Jafri SM, Lavine S, Field BE, Ahorozian M, Carlson R. Left ventricular diastolic function in sepsis. Crit Care Med 1990; 18: 709-714.
11.
Poelaert J, Declerck C, Vogelaers D, Colardyn F, Visser CA. Left ventricular systolic and diastolic function in septic shock. Intensive Care Med 1997; 23: 553-560.
12.
Sturgess DJ, Marwick TH, Joyce CJ, Jones M, Venkatesh B. Tissue Doppler in critical illness: a retrospective cohort study. Crit Care 2007; 11: R97. doi: 10.1186/cc6114.
13.
Munt B, Jue J, Gin K, Fenwick J, Tweeddale M. Diastolic filling in human severe sepsis: an echocardiographic study. Crit Care Med 1998; 26: 1829-1833. doi: 10.1097/00003246-199811000-00023.
14.
McLean AS, Huang SJ, Hyams S, et al. Prognostic values of B-type natriuretic peptide in severe sepsis and septic shock. Crit Care Med 2007; 35: 1019-1026. doi: 10.1097/01.CCM.0000259469.24364.31.
15.
Pulido JN, Afessa B, Masaki M, et al. Clinical spectrum, frequency, and significance of myocardial dysfunction in severe sepsis and septic shock. Mayo Clin Proc 2012; 87: 620-628. doi: 10.1016/j.mayocp.2012.01.018.
16.
Micek ST, McEvoy C, McKenzie M, Hampton N, Doherty JA, Kollef MH. Fluid balance and cardiac function in septic shock as predictors of hospital mortality. Crit Care 2013; 17: R246. doi: 10.1186/cc13072.
17.
Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 17: 1321-1360. doi: 10.1093/ehjci/jew082.
18.
Clancy DJ, Scully T, Slama M, Huang S, McLean AS, Orde SR. Application of updated guidelines on diastolic dysfunction in patients with severe sepsis and septic shock. Ann Intensive Care 2017; 7: 121. doi: 10.1186/s13613-017-0342-x.
19.
Dalla K, Hallman C, Bech-Hanssen O, Haney M, Ricksten SE. Strain echocardiography identifies impaired longitudinal systolic function in patients with septic shock and preserved ejection fraction. Cardiovasc Ultrasound 2015; 13: 30. doi: 10.1186/s12947-015-0025-4.
20.
R Core Team. R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna 2015.
21.
Bergenzaun L1, Gudmundsson P, Öhlin H, et al. Assessing left ventricular systolic function in shock: evaluation of echocardiographic parameters in intensive care. Crit Care 2011; 15: R200. doi: 10.1186/cc10368.
22.
Chahal NS, Lim TK, Jain P, Chambers JC, Kooner JS, Senior R. Normative reference values for the tissue Doppler imaging parameters of left ventricular function: a population-based study. Eur J Echocardiogr 2010; 11: 51-56. doi: 10.1093/ejechocard/jep164.
23.
De Geer L, Engvall J, Oscarsson A. Strain echocardiography in septic shock – a comparison with systolic and diastolic function parameters, cardiac biomarkers and outcome. Crit Care 2015; 19: 122. doi: 10.1186/s13054-015-0857-1.
24.
Sturgess DJ, Parmar D, Dulhunty JM, Hedge R, Jarrett P, Udy A. A preliminary evaluation of plasma b-type natriuretic peptide as a screening test for left ventricular diastolic dysfunction in non-cardiac intensive care. Anaesth Intensive Care 2013; 41: 591-595. doi: 10.1177/0310057X1304100503.
25.
Orde SR, Pulido JN, Masaki M, et al. Outcome prediction in sepsis: speckle tracking echocardiography based assessment of myocardial function. Crit Care 2014; 18: R149. doi: 10.1186/cc13987.
26.
Clancy DJ, Slama M, Huang S, et al. Detecting impaired myocardial relaxation in sepsis with a novel tissue Doppler parameter (septal e’/s’). Crit Care 2017; 21: 175. doi: 10.1186/s13054-017-1727-9.
| eISSN: | 1731-2531 |
| ISSN: | 1642-5758 |
