|
|
|
|
DYNAMIC DIASTOLIC LEFT VENTRICULAR DYSFUNCTION IN CRITICAL ILLNESS
Konstantin Yastrebov, MD, PhD
Introduction: Large amount of data has been collected as a result of Transoesophageal Echocardiographic (TOE) assessment of the left ventricular (LV) systolic function. However little is still known about the left ventricular diastolic dysfunction (DD) in critically ill patients.
Results: Out of 166 critically ill patients, assesses in our unit with TOE (1997-2001), 82 (49%) had a degree of LV DD, 63 (38%) had global or regional LV systolic dysfunction. From 82 patients with LV DD, 33 patients (40%) had also a systolic dysfunction. There was no correlation found between diastolic and systolic LV dysfunction. There was no correlation found between the severity of DD and demographic data (mean age 68.7). 37%, p<0.001 of patients had restrictive pattern (3rd stage DD), 27%, p<0.001 had reduced LV filling (1st stage DD), and 12%, p<0.001 had pseudonormalisation (2nd stage). 11%, p<0.001 had an isolated regional LV DD. 28% had atypical parameters (indicating DD but not corresponding with standard classification of DD stages). Repeat studies indicated dynamic changes in all DD parameters.
Conclusions: LV DD is unrecognized frequent co-morbidity in critically ill patients. It is more frequent than systolic LV dysfunction. Its stages and severity can't be predicted based on patient's demographic data or status of systolic LV function. It expresses dynamic characteristics and carries parameters that frequently do not correspond with the widely accepted in cardiology classification of DD. TOE with TVI capabilities allows diagnosis of isolated regional diastolic LV dysfunction. Further research is required to reassess pathophysiological principles, classification and approaches to the diagnosis and treatment of myocardial dysfunction in critical illness.
|
|
|
|
|
