Medical-Surgical Intensive Care Unit, Limoges Teaching Hospital, Limoges, France.
Curr Opin Crit Care. 2013 Jun;19(3):242-9. doi: 10.1097/MCC.0b013e32836091c3.
Left-ventricular diastolic dysfunction is associated with various conditions frequently encountered in ICU patients. Due to prolonged relaxation and increased left-ventricular stiffness, patients with diastolic dysfunction are at high risk of developing abrupt pulmonary venous congestion. The present review describes the clinical spectrum of left-ventricular diastolic abnormalities in ICU patients.
Left-ventricular diastolic dysfunction is associated with a preserved ejection fraction in half of the patients presenting with acute pulmonary edema. These patients may have dramatic presentation, such as flash pulmonary edema during a hypertensive crisis. Left-ventricular diastolic dysfunction is frequently involved in patients who fail extubation and may trigger weaning pulmonary edema. Sepsis and myocardial ischemia may also be associated with left-ventricular diastolic dysfunction. The diagnosis of left-ventricular diastolic dysfunction practically relies on two-dimensional and Doppler echocardiography. Further large-scale clinical studies are needed to better characterize the prevalence, the clinical relevance and time-course of left-ventricular diastolic dysfunction in ICU patients.
Left-ventricular diastolic dysfunction accounts for a growing proportion of cardiogenic pulmonary edema and weaning failure in ICU patients. It may be reversible when induced by sepsis or myocardial ischemia. Its prognostic value in the ICU settings remains to be further investigated.
左心室舒张功能障碍与 ICU 患者中经常遇到的各种情况有关。由于舒张期延长和左心室僵硬度增加，舒张功能障碍患者发生急性肺静脉淤血的风险很高。本综述描述了 ICU 患者左心室舒张异常的临床谱。
左心室舒张功能障碍与一半出现急性肺水肿的患者的射血分数保留有关。这些患者可能会出现戏剧性的表现，例如高血压危象期间出现闪发性肺水肿。左心室舒张功能障碍在拔管失败的患者中很常见，并可能引发撤机性肺水肿。败血症和心肌缺血也可能与左心室舒张功能障碍有关。左心室舒张功能障碍的诊断实际上依赖于二维和多普勒超声心动图。需要进一步的大规模临床研究来更好地描述 ICU 患者左心室舒张功能障碍的患病率、临床相关性和时间进程。
左心室舒张功能障碍占 ICU 患者心源性肺水肿和撤机失败的比例越来越大。当由败血症或心肌缺血引起时，它可能是可逆的。其在 ICU 环境中的预后价值仍有待进一步研究。
