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Ventricular diastolic abnormalities in the critically ill

Vignon, Philippea,b,c

Current Opinion in Critical Care: June 2013 - Volume 19 - Issue 3 - p 242–249
doi: 10.1097/MCC.0b013e32836091c3
CARDIOPULMONARY MONITORING: Edited by Anthony S. McLean

Purpose of review: Left-ventricular diastolic dysfunction is associated with various conditions frequently encountered in ICU patients. Due to prolonged relaxation and increased left-ventricular stiffness, patients with diastolic dysfunction are at high risk of developing abrupt pulmonary venous congestion. The present review describes the clinical spectrum of left-ventricular diastolic abnormalities in ICU patients.

Recent findings: Left-ventricular diastolic dysfunction is associated with a preserved ejection fraction in half of the patients presenting with acute pulmonary edema. These patients may have dramatic presentation, such as flash pulmonary edema during a hypertensive crisis. Left-ventricular diastolic dysfunction is frequently involved in patients who fail extubation and may trigger weaning pulmonary edema. Sepsis and myocardial ischemia may also be associated with left-ventricular diastolic dysfunction. The diagnosis of left-ventricular diastolic dysfunction practically relies on two-dimensional and Doppler echocardiography. Further large-scale clinical studies are needed to better characterize the prevalence, the clinical relevance and time-course of left-ventricular diastolic dysfunction in ICU patients.

Summary: Left-ventricular diastolic dysfunction accounts for a growing proportion of cardiogenic pulmonary edema and weaning failure in ICU patients. It may be reversible when induced by sepsis or myocardial ischemia. Its prognostic value in the ICU settings remains to be further investigated.

aMedical-Surgical Intensive Care Unit, Limoges Teaching Hospital

bCenter of Clinical Investigation

cUniversity of Limoges, Limoges, France

Correspondence to Professor Philippe Vignon, MD, PhD, Réanimation Polyvalente, CHU Dupuytren, 2 Ave. Martin Luther King, 87042 Limoges, cedex, France. Tel: +33 5 55 05 62 40; fax: +33 5 55 05 62 44; e-mail: philippe.vignon@unilim.fr

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins