Diastolic dysfunction and severity as predictor of mortality in critically ill ICU patients in a Tertiary care centre - A Prospective observational study

Diastolic dysfunction  is a significant concern in critically ill patients admitted to the

intensive care unit , and it has been associated with increased morbidity and

mortality. The relationship between diastolic dysfunction and mortality in ICU patients is

multifaceted and influenced by several factors. Diastolic dysfunction can lead to

hemodynamic instability, making it harder to manage fluid balance and blood pressure in

critically ill patients. Patients with diastolic dysfunction may have a limited ability to increase

cardiac output in response to stress, leading to inadequate tissue perfusion. Poor cardiac

relaxation and elevated filling pressures can contribute to multi-organ dysfunction, a common

cause of mortality in ICU settings. Studies have shown that diastolic dysfunction is

independently associated with higher mortality rates in ICU patients. The severity of diastolic

dysfunction correlates with worse outcomes. ICU patients with diastolic dysfunction often

have longer ICU and hospital stays, increased need for mechanical ventilation, and higher

rates of complications. Addressing underlying conditions such as hypertension, diabetes, and

sepsis can help improve diastolic function. Early detection and appropriate management of

diastolic dysfunction, along with addressing underlying causes and careful hemodynamic

monitoring, are essential to improve outcomes in these patients. Continued research and

awareness are necessary to refine strategies for managing diastolic dysfunction in the ICU

settings. I will be undertaking this study as very less number of studies have been done till

date and to find out the association between diastolic dysfunction and mortality in critically

ill ICU patients.

Diastolic left ventricular (LV) dysfunction is associated with slow LV relaxation and

increased LV stiffness. Cardiac dysfunction in critical care patients may contribute to

multiorgan failure and increased mortality . Diastolic dysfunction can be the reason for

intensive care unit (ICU) admission, or be a result from critical illness.

Doppler echocardiographic assessment of early (E-wave) and late (A-wave) diastolic filling

and the mitral annular early diastolic velocity (e’), as well as E/A and E/e’ ratios, have been

used to diagnose diastolic dysfunction . Abnormal values with different cut-offs have been

associated with worse outcomes and increased mortality.

Sanfilippo F et al documented in patients with sepsis, diastolic dysfunction has a better

correlation with mortality than left ventricular systolic dysfunction . Increased mortality is

seen with sepsis patients with diastolic dysfunction and higher grades with worst outcomes .

Lanspa et al proposed a simple definition for diastolic dysfunction based on Echo . According

to this definition, patients with e’sep < 8 are diagnosed to have diastolic dysfunction. They

are further graded based on E/e’; < 8, patients are classified as grade 1; 8–13, patients are

classified as grade 2; and if over 13, patients are classified as grade 3 .These parameters

outperformed ASE American Society of Echocardiography 2009 and 2016 guidelines for

diastolic dysfunction .

Diastolic dysfunction could be more prevalent in patients with more advanced disease or be a

part of multiorgan failure with an associated increase in mortality. Patients with diastolic

dysfunction have lower PaO2/FiO2 secondary to pulmonary congestion caused by higher

filling pressures , which has been shown to lead to extubation failure .