Assessing Diastolic Function as an Important Tool for Clinical Decision-making in Critically Ill Patients

Figures

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  Figure 1. Chest X-ray on admission (A) and at discharge (B). Note the disappearance of bilateral pleural effusion and pulmonary congestion at discharge.

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  Figure 2. Mitral inflow pattern on admission (A) and at discharge (B). Mitral inflow pattern changed from a restrictive physiology at admission to a relaxation abnormality at discharge, suggesting significant improvement in left ventricular filling pressure and diastolic function.

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  Figure 3. Mitral flow pattern had a very low E velocity, suggesting volume depletion or dehydration.

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  Figure 4. Changes after diuretic therapy in patients with abnormal relaxation. Patients with grade 1 diastolic dysfunction (abnormal relaxation) will not benefit from diuretic therapy because their filling pressure is usually not elevated.

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  Figure 5. Chest X-ray (A) and chest CT (B) interpreted as pulmonary edema.

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  Figure 6. Mitral inflow and tricuspid regurgitation velocity pattern 5 months prior (A) and on admission (B).

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  Figure 7. Chest X-ray on admission (A) and 4 days after intensive diuretic therapy (B). Despite intensive diuretic therapy, pulmonary vascular markings and consolidation did not improve.

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  Figure 8. Schematic diagram of the titration profile of patients enrolled in the study according to baseline MFP and acute changes in MFP after loading manipulations (adapted from reference 14). MFP: mitral flow pattern, NTP: nitroprusside infusion, PLL: passive leg lifting.

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  Figure 9. Effect of beta blocker administration in patients with a restrictive physiology. Prolonging the diastolic filling time with a beta blocker in the presence of a restrictive physiology would not be beneficial and could even be harmful in patients with a restrictive physiology due to a decrease in cardiac output in accordance with a decrease in heart rate.