Left Ventricle Tissue Doppler Imaging Predicts Disease Severity in Septic Patients Newly Admitted in an Emergency Unit

Tissue Doppler assessment of diastolic function and relationship with mortality in critically ill septic patients: a systematic review and meta-analysis

“…Twenty-one studies were excluded; thus, the 18 remaining papers were selected for the qualitative analysis from Medline. [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] The search on EMBASE restricted to studies published after 2013 produced 13 and 755 titles for the restrictive and the liberal approach, respectively. One international conference abstract not yet available in Medline provided unspecified E/e 0 values in the target population of our study.…”

“…43 Two of these studies included both patients with sepsis, severe sepsis and septic shock, 40 44 but only one group of authors provided reliable values including only patients with severe sepsis and septic shock (thus excluding those with sepsis). Therefore, only one study was included in the analysis, 40 while the other was excluded from the quantitative synthesis, 44 leaving finally 17 studies. One study was conducted with transoesophageal echocardiography; this study reported only e 0 values and was included in the secondary analysis for e 0 values only because the corresponding authors could not provide data on E/e 0 .…”

“…Another secondary analysis was conducted excluding a total of four studies because of the timing of echocardiographic assessment. Three of the studies conducted a very early assessment [in the emergency department, 40 within 2 h 45 and within 6 h of intensive care unit (ICU) admission 28 ] or a late evaluation (performed up to one week from ICU admission 43 ) These analyses did not show significant changes in the results of the overall primary outcome (both remaining significant: e 0 , SMD 0.38; 95% CI 0.10, 0.66; P¼0.008; I 2 ¼81%; E/e 0 , SMD -0.36; 95% CI -0.59, -0.13; P¼0.002; I 2 ¼71%).…”

Impact of New-Onset Left Ventricular Dysfunction on Outcomes in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock

“…Left ventricular diastolic dysfunction has been associated with worse ICU and hospital outcomes in many populations including those with severe sepsis and septic shock. 1,[33][34][35][36][37][38][39] In patients with severe sepsis, a meta-analysis showed LVDD to be associated with mortality at the longest follow-up (relative risk 1.82, 95% CI 1.12-2.97, P ¼ .02). 1 In this exploratory analysis on patients with concurrent IMV, we showed a statistically nonsignificant trend toward worse in-hospital outcomes.…”

“…In our population, LVDD was associated with clinically higher duration of IMV (6.9 vs 5.4 days; P ¼ .77); however, this did not achieve statistical significance. Further, appropriately powered analyses are warranted to evaluate this clinically relevant association, since these could (33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47) .61…”