A simplified definition of diastolic function in sepsis, compared against standard definitions
Abstract Background Guidelines for grading diastolic dysfunction poorly categorize septic patients. We compared how well the American Society of Echocardiography (ASE) 2009 and 2016 definitions and a simplified definition categorized septic patients. Methods We studied septic patients who received a...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | Journal of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40560-019-0367-3 |
| _version_ | 1811323354599129088 |
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| author | Michael J. Lanspa Troy D. Olsen Emily L. Wilson Mary Louise Leguyader Eliotte L. Hirshberg Jeffrey L. Anderson Samuel M. Brown Colin K. Grissom |
| author_facet | Michael J. Lanspa Troy D. Olsen Emily L. Wilson Mary Louise Leguyader Eliotte L. Hirshberg Jeffrey L. Anderson Samuel M. Brown Colin K. Grissom |
| author_sort | Michael J. Lanspa |
| collection | DOAJ |
| description | Abstract Background Guidelines for grading diastolic dysfunction poorly categorize septic patients. We compared how well the American Society of Echocardiography (ASE) 2009 and 2016 definitions and a simplified definition categorized septic patients. Methods We studied septic patients who received a transthoracic echocardiogram within 24 h of admission to an ICU. We categorized patients according to ASE 2009 and 2016 definitions and a definition using E/e’, a surrogate for left ventricular filling pressure. We assessed 28-day all-cause mortality and the presence of pre-existing diabetes, hypertension, or myocardial infarction. We tested for associations among diastolic grade, comorbidities, and outcomes using logistic regression. Results We studied 398 patients. Mortality was 23%. The simplified definition categorized more patients than ASE 2016 (78% vs. 71%, p = 0.035); both definitions categorized more patients than ASE 2009 (34%, p < 0.001 for both comparisons). Higher grades of diastolic dysfunction were associated with hypertension (ASE 2016, simplified), myocardial infarction (ASE 2009, simplified), and diabetes (simplified). Grade of diastolic dysfunction was not associated with mortality by any definition. Of 199 patients categorized as normal by ASE 2016, 40% had an abnormal E/e′ > 9 and 7% had a severely abnormal E/e′ > 13. Conclusions The ASE 2016 definition categorizes more septic patients than the ASE 2009 definition, but it does not categorize the diastolic function of a third of septic patients. ASE 2016 designates many patients with elevated E/e′ as normal. A simplified definition categorized patients with less ambiguity and is associated with relevant comorbidities. |
| first_indexed | 2024-04-13T13:52:27Z |
| format | Article |
| id | doaj.art-be857d7a5d6940b8b461a9c92def0c29 |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-04-13T13:52:27Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-be857d7a5d6940b8b461a9c92def0c292022-12-22T02:44:17ZengBMCJournal of Intensive Care2052-04922019-02-01711810.1186/s40560-019-0367-3A simplified definition of diastolic function in sepsis, compared against standard definitionsMichael J. Lanspa0Troy D. Olsen1Emily L. Wilson2Mary Louise Leguyader3Eliotte L. Hirshberg4Jeffrey L. Anderson5Samuel M. Brown6Colin K. Grissom7Critical Care Echocardiography Service, Intermountain Medical CenterCritical Care Echocardiography Service, Intermountain Medical CenterCritical Care Echocardiography Service, Intermountain Medical CenterDepartment of Internal Medicine, University of UtahCritical Care Echocardiography Service, Intermountain Medical CenterIntermountain Medical Center Heart InstituteCritical Care Echocardiography Service, Intermountain Medical CenterCritical Care Echocardiography Service, Intermountain Medical CenterAbstract Background Guidelines for grading diastolic dysfunction poorly categorize septic patients. We compared how well the American Society of Echocardiography (ASE) 2009 and 2016 definitions and a simplified definition categorized septic patients. Methods We studied septic patients who received a transthoracic echocardiogram within 24 h of admission to an ICU. We categorized patients according to ASE 2009 and 2016 definitions and a definition using E/e’, a surrogate for left ventricular filling pressure. We assessed 28-day all-cause mortality and the presence of pre-existing diabetes, hypertension, or myocardial infarction. We tested for associations among diastolic grade, comorbidities, and outcomes using logistic regression. Results We studied 398 patients. Mortality was 23%. The simplified definition categorized more patients than ASE 2016 (78% vs. 71%, p = 0.035); both definitions categorized more patients than ASE 2009 (34%, p < 0.001 for both comparisons). Higher grades of diastolic dysfunction were associated with hypertension (ASE 2016, simplified), myocardial infarction (ASE 2009, simplified), and diabetes (simplified). Grade of diastolic dysfunction was not associated with mortality by any definition. Of 199 patients categorized as normal by ASE 2016, 40% had an abnormal E/e′ > 9 and 7% had a severely abnormal E/e′ > 13. Conclusions The ASE 2016 definition categorizes more septic patients than the ASE 2009 definition, but it does not categorize the diastolic function of a third of septic patients. ASE 2016 designates many patients with elevated E/e′ as normal. A simplified definition categorized patients with less ambiguity and is associated with relevant comorbidities.http://link.springer.com/article/10.1186/s40560-019-0367-3EchocardiographySeptic cardiomyopathyDiastolic dysfunctionPreload |
| spellingShingle | Michael J. Lanspa Troy D. Olsen Emily L. Wilson Mary Louise Leguyader Eliotte L. Hirshberg Jeffrey L. Anderson Samuel M. Brown Colin K. Grissom A simplified definition of diastolic function in sepsis, compared against standard definitions Journal of Intensive Care Echocardiography Septic cardiomyopathy Diastolic dysfunction Preload |
| title | A simplified definition of diastolic function in sepsis, compared against standard definitions |
| title_full | A simplified definition of diastolic function in sepsis, compared against standard definitions |
| title_fullStr | A simplified definition of diastolic function in sepsis, compared against standard definitions |
| title_full_unstemmed | A simplified definition of diastolic function in sepsis, compared against standard definitions |
| title_short | A simplified definition of diastolic function in sepsis, compared against standard definitions |
| title_sort | simplified definition of diastolic function in sepsis compared against standard definitions |
| topic | Echocardiography Septic cardiomyopathy Diastolic dysfunction Preload |
| url | http://link.springer.com/article/10.1186/s40560-019-0367-3 |
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