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Review
. 2018 Oct 29;8(1):100.
doi: 10.1186/s13613-018-0447-x.

Practical approach to diastolic dysfunction in light of the new guidelines and clinical applications in the operating room and in the intensive care

F Sanfilippo  1 , S Scolletta  2 , A Morelli  3 , A Vieillard-Baron  4
Affiliations
Review

Practical approach to diastolic dysfunction in light of the new guidelines and clinical applications in the operating room and in the intensive care

F Sanfilippo et al. Ann Intensive Care. .

Erratum in

Abstract

There is growing evidence both in the perioperative period and in the field of intensive care (ICU) on the association between left ventricular diastolic dysfunction (LVDD) and worse outcomes in patients. The recent American Society of Echocardiography and European Association of Cardiovascular Imaging joint recommendations have tried to simplify the diagnosis and the grading of LVDD. However, both an often unknown pre-morbid LV diastolic function and the presence of several confounders-i.e., use of vasopressors, positive pressure ventilation, volume loading-make the proposed parameters difficult to interpret, especially in the ICU. Among the proposed parameters for diagnosis and grading of LVDD, the two tissue Doppler imaging-derived variables e' and E/e' seem most reliable. However, these are not devoid of limitations. In the present review, we aim at rationalizing the applicability of the recent recommendations to the perioperative and ICU areas, discussing the clinical meaning and echocardiographic findings of different grades of LVDD, describing the impact of LVDD on patients' outcomes and providing some hints on the management of patients with LVDD.

Keywords: Critical care; Diastolic function; Sepsis; Systolic function; Weaning failure.

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Figures

Fig. 1
Fig. 1
Progression from normal diastolic function to worsening degrees of left ventricular diastolic dysfunction (LVDD). The top row a illustrates the respective changes in left atrial (LA) and left ventricular (LV) pressures with the progression of LVDD. The middle and bottom rows show examples of the patterns of transmitral blood flow (b) and of tissue Doppler imaging of the mitral annulus (c). These patterns are shown for each stage of LVDD, with corresponding changes of the E and e′ (early), and A and a′ (atrial) waves. From left to right, 2a: normal diastolic function (E > A; e′ > a′); 2b: LVDD grade I (E < A; e′ < a′); 2c: LVDD grade II (E > A; e′ < a′); 2d: LVDD grade III (E ≫ A; e′ ≪ a′)
Fig. 2
Fig. 2
Algorithm for grading of left ventricular diastolic dysfunction (LVDD) in outpatients according to the 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging (ASE/EACVI) guidelines
Fig. 3
Fig. 3
Suggestions for the management of critically ill patients with left ventricular diastolic dysfunction (LVDD)
See this image and copyright information in PMC

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