Detecting impaired myocardial relaxation in sepsis with a novel tissue Doppler parameter (septal e′/s′)

Abstract

BackgroundLeft ventricular diastolic dysfunction is associated with mortality outcomes in severe sepsis and septic shock. There are ongoing issues with diagnosing diastolic dysfunction in this cohort, partly owing to the poor applicability of traditional parameters in the hyperdynamic circulation. In this feasibility study, we sought to assess the utility of a novel parameter (septal e′/s′) to identify diastolic dysfunction in patients with severe sepsis and septic shock who had normal systolic function against the 2016 American Society Echocardiography and European Association of Cardiovascular Imaging (ASE/EACI) guidelines on diastolic dysfunction.MethodsIn this prospective observational pilot study, patients identified as having severe sepsis and septic shock underwent transthoracic echocardiography on day 1 and day 3 of their intensive care unit admission. In patients with normal systolic function, septal e′/s′ was calculated using the peak modal velocity of the s′ compared with the e′ from the septal annulus tissue Doppler imaging and compared with their diastolic grade according to the 2016 ASE/EACI guidelines on diastolic dysfunction.ResultsOn day 1 of admission, 44 of 62 patients with severe sepsis and septic shock had normal systolic function. There was a strong association of those with diastolic dysfunction having a reduced septal e′/s′ compared with patients with normal diastolic function (AUC 0.91). A similar relationship was seen with patients who had indeterminate diastolic dysfunction. On day 3, 37 patients had normal systolic function. Again, there was a strong association of those with diastolic dysfunction and a reduced septal e′/s′ (AUC 0.95).ConclusionsA reduction in septal e′/s′ may indicate diastolic dysfunction in patients with severe sepsis and septic shock who have normal systolic function. As opposed to limited traditional measures of diastolic dysfunction, it is applicable in those with hyperdynamic systolic function.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1727-9) contains supplementary material, which is available to authorized users.

Arterial Stiffness and Left Ventricular Diastolic Function in Endurance Athletes

“…The peak early diastolic mitral annular velocities (e') were recorded at the septal site of the mitral annulus. The septal site was considered to have less translational movement and less Doppler beam angle error [16,17]. The e' was assessed as a feature of LV diastolic function [18].…”

The impact of cardiac loading on a novel metric of left ventricular diastolic function in healthy middle‐aged adults: Systolic–diastolic coupling

“…Prior studies have shown a linear relationship between systolic contraction and early diastolic recoil in healthy adults and have found heterogeneous relationships in disease states, such as heart failure, dilated cardiomyopathy, and sepsis (Clancy et al, 2017 ; Friedberg et al, 1985 ; Koh et al, 2010 ). Friedberg et al found a linear relationship between e’ and s’ in children and the s’/e’ ratio was altered in children with dilated cardiomyopathy while Koh et al found s’ and e’ remained associated in children with LV non‐compaction (Friedberg et al, 1985 ; Koh et al, 2010 ).…”

“…Tissue Doppler imaging (TDI) was chosen to define LV longitudinal motion for several reasons. First, TDI permitted simultaneous measurement of the peak velocities and excursion distances of the mitral annulus for comparison (Clancy et al, 2017 ; Friedberg et al, 1985 ; Koh et al, 2010 ; Popovic et al, 2011 ). Second, TDI VTI is a previously validated measure of annular excursion (Hayashi et al, 2006 ; Manouras et al, 2009 ; Peverill, 2019 ).…”

“…Friedberg et al found a linear relationship between e' and s' in children and the s'/e' ratio was altered in children with dilated cardiomyopathy while Koh et al found s' and e' remained associated in children with LV non-compaction (Friedberg et al, 1985;Koh et al, 2010). Clancy et al found diminished e'/s' ratio in adults with severe sepsis and a strong association with "diastolic dysfunction" (Clancy et al, 2017). These studies are cross-sectional and use velocities as their metric of systolic-diastolic coupling, which may account for the heterogeneous results in patients with varied loading conditions (HF vs. sepsis, F I G U R E 3 Metrics of systolic-diastolic coupling across loading conditions show different response to preload: left panel demonstrates no change in excursion (ED exc /S exc ) ratio with changes to pulmonary capillary wedge pressure (PCWP) while right panel show a significant change in velocity (E'/S') ratio with changes to PCWP.…”

Utility of tissue Doppler imaging of systolic function to diagnose diastolic dysfunction in critically ill patients

“…Unfortunately, speckle tracking echocardiography is not available in most Polish intensive care units, so we try to apply tissue Doppler in many clinical scenarios. A very interesting application of tissue Doppler was proposed by Clancy et al [26]. They proposed a novel parameter (septal e'/s') to identify diastolic dysfunction in patients with severe sepsis and septic shock who had normal systolic function.…”