Tissue Doppler assessment of diastolic function and relationship with mortality in critically ill septic patients: a systematic review and meta-analysis
| Autor: | Giora Landesberg, Maurizio Cecconi, Antoine Vieillard-Baron, Filippo Sanfilippo, Antonio Arcadipane, N. Fletcher, Carlos Corredor |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Critical Illness Comorbidity 030204 cardiovascular system & hematology Doppler imaging Sepsis 03 medical and health sciences 0302 clinical medicine Diastole Internal medicine Intensive care medicine Heart valve Stage (cooking) Heart Failure Diastolic Septic shock business.industry 030208 emergency & critical care medicine medicine.disease Echocardiography Doppler Confidence interval Surgery Anesthesiology and Pain Medicine medicine.anatomical_structure Meta-analysis Cardiology business |
| Zdroj: | British Journal of Anaesthesia. 119:583-594 |
| ISSN: | 0007-0912 |
| DOI: | 10.1093/bja/aex254 |
| Popis: | Background Myocardial dysfunction may contribute to circulatory failure in sepsis. There is growing evidence of an association between left ventricular diastolic dysfunction (LVDD) and mortality in septic patients. Utilizing echocardiography, we know that tissue Doppler imaging (TDI) variables e′ and E/e′ are reliable predictors of LVDD and are useful measurements to estimate left ventricular (LV) filling pressures. Methods We conducted a systematic review and meta-analysis to investigate the association of e′ and E/e′ with mortality of patients with severe sepsis or septic shock. In the primary analysis, we included studies providing transthoracic TDI data for e′ and E/e′ and their association with mortality. Subgroup analyses were conducted according to myocardial regional focus of TDI assessment (septal, lateral or averaged). Three secondary analyses were performed: one included data from a transoesophageal study, another excluded studies reporting data at a very early ( 48 h) stage following diagnosis, and the third pooled data only from studies excluding patients with heart valve disease. Results The primary analysis included 16 studies with 1507 patients with severe sepsis and/or septic shock. A significant association was found between mortality and both lower e′ [standard mean difference (SMD) 0.33; 95% confidence interval (CI): 0.05, 0.62; P=0.02] and higher E/e′ (SMD –0.33; 95% CI: –0.57, –0.10; P=0.006). In the subgroup analyses, only the lateral TDI values showed significant association with mortality (lower e′ SMD 0.45; 95% CI: 0.11, 0.78; P=0.009; higher E/e′ SMD –0.49; 95% CI: –0.76, –0.22; P=0.0003). The findings of the primary analysis were confirmed by all secondary analyses. Conclusions There is a strong association between both lower e′ and higher E/e′ and mortality in septic patients. |
| Databáze: | OpenAIRE |
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