Prevalence of Left Ventricular Diastolic Dysfunction and Prognostic Value in Septic Shock Patients According to Different Guidelines: Comparison Between Contemporary Cardiological Algorithms and Simplified Approaches

BACKGROUND: Diagnosis of left ventricular diastolic dysfunction (LVDD) in the context of septic shock is challenging. We aimed to compare different algorithms applied to septic patients. METHODS: Secondary analysis of a prospective, single-center study of 98 consecutive adult septic shock patients undergoing comprehensive speckle-tracking echocardiography within 24 h of ICU admission. We studied the prevalence and the prognostic value of five LVDD diagnostic algorithms:2016-American Society of Echocardiography (ASE)/European Association CardioVascular Imaging(EACVI), 2024-British Society of Echocardiography(BSE), 2025-ASE, Lanspa-simplified criteria, and a further Lanspa-modified version hereby proposed (adding LVDD diagnosis when LV ejection fraction< 50%, as in 2016-ASE-EACVI guidelines). Logistic regression and Kaplan-Meier curves were used to explore the association between algorithms and 30-day mortality. RESULTS: The prevalence of LVDD on day 1 varied widely, ranging from 32.7%(Lanspa) to 72.4%(2024-BSE). Concordance between the three cardiology guidelines ranged from slight to moderate: the lowest agreement among them was observed between the 2016-ASE/EACVI and the 2025-ASE criteria(55.1%, Kappa 0.10), whereas the highest agreement across all five algorithms was seen between the 2016-ASE/EACVI and the Lanspa-modified criteria(88.8%, Kappa 0.77). When correcting for severity score, need for invasive ventilation, and norepinephrine dose, independent prognostic values for 30-day mortality were observed only for the 2025-ASE, the Lanspa and the Lanspa-modified algorithms, but all algorithms had similar predictive performances. CONCLUSIONS: The prevalence of LVDD in septic shock is highly dependent on the diagnostic algorithm utilized. Although only the 2025-ASE, Lanspa, and Lanspa-modified algorithms demonstrated independent prognostic value after multivariable adjustment, prognostic discrimination for 30-day mortality was moderate and comparable across all approaches.