A simplified definition of diastolic dysfunction categorized 87% of patients with severe sepsis or septic shock compared to 35% using the standard ASE 2009 definition.
Observational (n=167)
Blinded to clinical outcomes
No
Does a simplified echocardiographic definition of diastolic dysfunction categorize more patients with severe sepsis or septic shock compared to the ASE 2009 definition?
A simplified echocardiographic definition of diastolic dysfunction using only e' and E/e' categorizes significantly more septic patients than the ASE 2009 guidelines while maintaining similar associations with clinical outcomes and comorbidities.
Tasa de eventos absoluta: 87% vs 35%
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Lanspa et al. (Wed,) conducted a observational in Severe sepsis or septic shock (n=167). Simplified definition of diastolic dysfunction vs. ASE 2009 definition was evaluated on Categorization of diastolic function. A simplified definition of diastolic dysfunction categorized 87% of patients with severe sepsis or septic shock compared to 35% using the standard ASE 2009 definition.