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

Background
Diastolic dysfunction might be associated with increased mortality in severe sepsis and septic shock. In 2016 new American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines were published. They simplify our approach to diastolic dysfunction recognition, but they were not validated in critical care settings. The aim of the study was to assess the applicability of systolic tissue Doppler imaging of left ventricle in patients with and without diastolic dysfunction classified on the basis of the new guidelines.

Methods
Two echocardiographers analyzed transthoracic echocardiography (TTE) exa­minations and assigned patients according to ASE/EASCVI guidelines to three groups: patients with systolic dysfunction and diastolic dysfunction, patients with normal systolic function and diastolic dysfunction, and patients with normal systolic and diastolic function.

Results
We performed 593 examinations in 320 patients and 390 examinations in 200 patients were included in the study. In 264 examinations with ejection fraction (EF) < 55% systolic and diastolic dysfunction was diagnosed (group 1). In 114 examinations with EF ≥ 55% normal systolic and diastolic function was diagnosed (group 2). In 12 examinations with EF ≥ 55% normal systolic and abnormal diastolic dysfunction was diagnosed (group 3). After analyzing mean systolic tissue Doppler of the mitral annulus we found a statistically significant difference between group 1 and 2 (P < 0.0001) and between group 2 and 3 (P < 0.0001). The difference in values of means in group 1 vs. 3 was not statistically significant (P = 0.853).

Conclusions
Systolic tissue Doppler analysis of mitral annulus might help to diagnose diastolic dysfunction especially in patients with preserved ejection fraction.