Lanspa Michael J, Gutsche Andrea R, Wilson Emily L, Olsen Troy D, Hirshberg Eliotte L, Knox Daniel B, Brown Samuel M, Grissom Colin K
Critical Care Echocardiography Service, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT, 84157, USA.
Division of Pulmonary and Critical Care Medicine, University of Utah, 30 North 1900 East, 701 Wintrobe Building, Salt Lake City, UT, 84132, USA.
Crit Care. 2016 Aug 4;20(1):243. doi: 10.1186/s13054-016-1421-3.
Left ventricular diastolic dysfunction is common in patients with severe sepsis or septic shock, but the best approach to categorization is unknown. We assessed the association of common measures of diastolic function with clinical outcomes and tested the utility of a simplified definition of diastolic dysfunction against the American Society of Echocardiography (ASE) 2009 definition.
In this prospective observational study, patients with severe sepsis or septic shock underwent transthoracic echocardiography within 24 h of onset of sepsis (median 4.3 h). We measured echocardiographic parameters of diastolic function and used random forest analysis to assess their association with clinical outcomes (28-day mortality and ICU-free days to day 28) and thereby suggest a simplified definition. We then compared patients categorized by the ASE 2009 definition and our simplified definition.
We studied 167 patients. The ASE 2009 definition categorized only 35 % of patients. Random forest analysis demonstrated that the left atrial volume index and deceleration time, central to the ASE 2009 definition, were not associated with clinical outcomes. Our simplified definition used only e' and E/e', omitting the other measurements. The simplified definition categorized 87 % of patients. Patients categorized by either ASE 2009 or our novel definition had similar clinical outcomes. In both definitions, worsened diastolic function was associated with increased prevalence of ischemic heart disease, diabetes, and hypertension.
A novel, simplified definition of diastolic dysfunction categorized more patients with sepsis than ASE 2009 definition. Patients categorized according to the simplified definition did not differ from patients categorized according to the ASE 2009 definition in respect to clinical outcome or comorbidities.
左心室舒张功能障碍在严重脓毒症或脓毒性休克患者中很常见，但最佳的分类方法尚不清楚。我们评估了舒张功能常用测量指标与临床结局之间的关联，并针对美国超声心动图学会（ASE）2009年的定义测试了舒张功能障碍简化定义的实用性。
在这项前瞻性观察性研究中，严重脓毒症或脓毒性休克患者在脓毒症发作后24小时内（中位时间4.3小时）接受了经胸超声心动图检查。我们测量了舒张功能的超声心动图参数，并使用随机森林分析来评估它们与临床结局（28天死亡率和至第28天无ICU天数）之间的关联，从而提出一个简化定义。然后，我们比较了根据ASE 2009年定义和我们的简化定义分类的患者。
我们研究了167例患者。ASE 2009年的定义仅对35%的患者进行了分类。随机森林分析表明，ASE 2009年定义的核心指标左心房容积指数和减速时间与临床结局无关。我们的简化定义仅使用e'和E/e'，省略了其他测量指标。简化定义对87%的患者进行了分类。根据ASE 2009年定义或我们的新定义分类的患者具有相似的临床结局。在这两种定义中。舒张功能恶化与缺血性心脏病、糖尿病和高血压的患病率增加有关。
与ASE 2009年定义相比，一种新的、简化的舒张功能障碍定义对更多脓毒症患者进行了分类。根据简化定义分类的患者在临床结局或合并症方面与根据ASE 2009年定义分类的患者没有差异。
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