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2026, Number 2

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Med Crit 2026; 40 (2)

Diastolic dysfunction in patients with sepsis and septic shock in the Intensive Care Unit

González MKI, Ramírez RP

Language: Spanish
References: 35
Page: 130-135
PDF size: 587.83 Kb.


ABSTRACT

Introduction: diastolic dysfunction refers to an impairment in the heart’s ability to relax and fill adequately without a significant increase in intraventricular pressure during the diastolic phase of the cardiac cycle. This condition can lead to heart failure with preserved ejection fraction and is a significant cause of morbidity and mortality. Diastolic dysfunction is a common finding in critically ill patients, characterized by a progressive impairment of muscle relaxation that leads to decreased left ventricular compliance with pressures exerted by the volume from the left atrium. In septic patients, it has been linked to one of the cornerstones of treatment: fluid resuscitation. It is a frequent condition associated with increased morbidity and mortality. Objective: to describe the incidence of diastolic dysfunction in patients diagnosed with septic shock admitted to the Intensive Care Unit (ICU). Material and methods: an analytical, prospective, longitudinal study was conducted, including 19 patients admitted to the intensive care unit with a diagnosis of septic shock between April 1, 2025, and May 30, 2025, who underwent point-of-care ultrasound (POCUS) for the timely and accurate diagnosis of diastolic dysfunction. Results: a total of 19 patients with septic shock were studied; 52.6% were male and 47.4% female. The mean age was 61.6 years. The 19-59 and 70-82 age groups represented 36.8% of the cases, respectively. 78.9% of the patients had comorbidities: 62.3% had a history of hypertension, 36.8% had diabetes, and 5.3% had liver failure. In 73.75% of cases, the focus of infection for septic shock was pulmonary, and in 10.5% it was neurological. Diastolic function was normal in 31.6% of cases, indeterminate in 26.3%, and diastolic dysfunction in 42.1% (15.8% grade I, 5.3% grade II, and 21.1% grade III). The reason for discharge from the ICU had a frequency of 52.6% and the mortality rate was 47.4%, being higher in the group of patients with diastolic dysfunction (75% vs 60% for indeterminate and 0% for normal function, p = 0.017). Conclusion: diastolic dysfunction is common in septic patients, and its association with mortality is well established. Transthoracic echocardiography is an indispensable, non-invasive, bedside tool that helps us establish the diagnosis and thus determine optimal treatment.


REFERENCES

  1. Gaieski DF, et al. Edwards JM, Kallan MJ, Carr BG.Benchmarking the incidence and mortality of severe sepsis inthe United States. Crit Care Med. 2013;41(5):1167-1174.

  2. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, KnoblichB, et al. Early goal-directed therapy in the treatment of severesepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.

  3. Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA,Pike F, et al. A randomized trial of protocol-based care for earlyseptic shock. N Engl J Med. 2014;370(18):1683-1693.

  4. National Heart, Lung, and Blood Institute Acute RespiratoryDistress Syndrome (ARDS) Clinical Trials Network; WiedemannHP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, et al.Comparison of two fluid-management strategies in acute lunginjury. N Engl J Med. 2006;354(24):2564-2575.

  5. Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluidresuscitation in septic shock: a positive fluid balance andelevated central venous pressure are associated with increasedmortality. Crit Care Med. 2011;39(2):259-265.

  6. Lanspa MJ, Olsen TD, Wilson EL, Leguyader ML, Hirshberg EL,Anderson JL, et al. A simplified definition of diastolic function insepsis, compared against standard definitions. J Intensive Care.2019;7:14. doi: 10.1186/s40560-019-0367-3.

  7. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, DokainishH, Edvardsen T, et al. Recommendations for the evaluationof left ventricular diastolic function by echocardiography: anupdate from the American Society of Echocardiography andthe European Association of Cardiovascular Imaging. J Am SocEchocardiogr. 2016;29(4):277-314.

  8. McDiarmid AK, Pellicori P, Cleland JG, Plein S. Taxonomyof segmental myocardial systolic dysfunction. Eur Heart J.2017;38(13):942-954. doi: 10.1093/eurheartj/ehw140.

  9. Jennings RB, Reimer KA. The cell biology of acute myocardialischemia. Annu Rev Med. 1991;42:225-246.

  10. Lockie T, Nagel E, Redwood S, Plein S. Use of cardiovascularmagnetic resonance imaging in acute coronary syndromes.Circulation 2009;119(12):1671-1168.

  11. Duncker DJ, Schulz R, Ferrari R, Garcia-Dorado D, GuarnieriC, Heusch G, Verdouw PD. “Myocardial stunning” remainingquestions. Cardiovasc Res. 1998;38(3):549-558.

  12. Kloner RA, Braunwald E. Observations on experimentalmyocardial ischaemia. Cardiovasc Res. 1980;14(7):371-395.

  13. Dokainish H. Left ventricular diastolic function and dysfunction:central role of echocardiography. Glob Cardiol Sci Pract.2015:2025:3. doi: 10.5339/gcsp.2015.3.

  14. Paulus WJ, Tschope C, Sanderson JE, Rusconi C, FlachskampfFA, Rademakers FE et al. How to diagnose diastolic heartfailure: a consensus statement on the diagnosis of heart failurewith normal left ventricular ejection fraction by the Heart Failureand Echocardiography Associations of the European Society ofCardiology. Eur Heart J. 2007;28(20):2539-2550.

  15. Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, OhJK, Tajik AJ, et al. Left atrial size: physiologic determinants andclinical applications. J Am Coll Cardiol. 2006;47(12):2357-2363.

  16. Oh JK, Hatle L, Tajik AJ, Little WC. Diastolic heart failure canbe diagnosed by comprehensive two-dimensional and Dopplerechocardiography. J Am Coll Cardiol. 2006;47(3):500-506.

  17. Rivas-Gotz C, Manolios M, Thohan V, Nagueh SF. Impact of leftventricular ejection fraction on estimation of left ventricular fillingpressures using tissue Doppler and flow propagation velocity.Am J Cardiol. 2003;91(6):780-784.

  18. Appleton CP, Galloway JM, Gonzalez MS, Gaballa M, BasnightMA. Estimation of left ventricular filling pressures using twodimensionaland Doppler echocardiography in adult patients withcardiac disease. Additional value of analyzing left atrial size, leftatrial ejection fraction and the difference in duration of pulmonaryvenous and mitral flow velocity at atrial contraction. J Am CollCardiol. 1993;22(7):1972-1982.

  19. Greenstein YY, Mayo PH. Evaluation of left ventricular diastolicfunction by the intensivist. Chest. 2018;153(3):723-732.

  20. Sanfilippo F, Corredor C, Fletcher N, Landesberg G, BenedettoU, Foex P, et al. Diastolic dysfunction and mortality in septicpatients: a systematic review and meta-analysis. Intensive CareMed. 2015;41(6):1004-1013.

  21. Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, HoferC, et al. Consensus on circulatory shock and hemodynamicmonitoring. Task force of the European Society of Intensive CareMedicine. Intensive Care Med. 2014;40(12):1795-1815.

  22. Suárez JC, López P, Mancebo J, Zapata L. Diastolic dysfunctionin the critically ill patient. Med Intensiva. 2016;40(8):499-510.

  23. Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD,Goodman S, et al. Diastolic dysfunction and mortality in severesepsis and septic shock. Eur Heart J. 2012;33(7):895-903.

  24. Parker MM, Shelhamer JH, Bacharach SL, Green MV, NatansonC, Frederick TM, et al. Profound but reversible myocardialdepression in patients with septic shock. Ann Intern Med.1984;100(4):483-490.

  25. Jardin F, Brun-Ney D, Auvert B, Beauchet A, Bourdarias JP.Sepsis-related cardio genic shock. Crit Care Med. 1990;18:1055-1060.

  26. Vieillard-Baron A, Schmitt JM, Beauchet A, Augarde R, PrinS, Page B, et al. Early preload adaptation in septic shock? Atransesophageal echocardiographic study. Anesthesiology.2001;94(3):400-406.

  27. Bouhemad B, Nicolas-Robin A, Arbelot C, Arthaud M, Féger F,Rouby JJ. Acute left ventricular dilatation and shock-inducedmyocardial dysfunction. Crit Care Med. 2009;37(2):441-447.

  28. Poelaert J, Declerck C, Vogelaers D, Colardyn F, Visser CA.Left ventricular systolica and diastolic function in septic shock.Intensive Care Med. 1997;23(5):553-560.

  29. Ikonomidis I, Nikolaou M, Dimopoulou I, Paraskevaidis I,Lekakis J, Mavrou I, et al. Association of left ventricular diastolicdysfunction with elevated NT-pro-BNP in general intensive careunit patients with preserve dejection fraction: a complementaryrole of tissue Doppler imaging parameters and NT-pro-BNPlevels for adverse outcome. Shock. 2010;33(2):141-148.

  30. Sturgess DJ, Marwick TH, Joyce C, Jenkins C, Jones M,Masci P, et al. Prediction of hospital out come in septic shock:a prospective comparison of tissue Doppler and cardiacbiomarkers. Crit Care. 2010;14(2):R44.

  31. Zanotti-Cavazzoni SL, Guglielmi M, Parrillo JE, Walker T,Dellinger RP, Hollenberg SM. Ventricular dilation is associatedwith improved cardiovascular performance and survival in sepsis.Chest. 2010;138(4):848-855.

  32. Kumar A, Haery C, Parrillo JE. Myocardial dysfunction inseptic shock: Part I. Clinical manifestation of cardiovasculardysfunction. J Cardiothorac Vasc Anesth. 2001;15(3):364-376.doi: S1053-0770(01)22786-4[pii]10.1053/jcan.2001.22317.

  33. Kumar A, Krieger A, Symeoneides S, Parrillo JE: Myocardialdysfunction in septic shock: Part II. Role of cytokines and nitricoxide. J Cardiothorac Vasc Anesth. 2001;15(4):485-511. doi:10.1053/ jcan.2001.25003.

  34. Brown SM, Pittman JE, Hirshberg EL, Jones JP, Lanspa MJ,Kuttler KG, et al. Diastolic dysfunction and mortality in earlysevere sepsis and septic shock: a prospective, observationalechocardiography study. Crit Ultrasound J. 2012;4(1):8.

  35. Pulido JN, Afessa B, Masaki M, Yuasa T, Gillespie S, HerasevichV, et al. Clinical spectrum, frequency, and significance ofmyocardial dysfunction in severe sepsis and septic shock. MayoClin Proc. 2012;87(7):620-628.




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