Diastolic dysfunction in intensive care unit: a pilot study in the general intensive care unit of l'aquila - Italy

Author(s):
Biancofiore V.1, Salve G.2, Ciccozzi A.3, Angeletti P.M.4, Prof. Marinangeli F.3, Zugaro A.5
Institute(s):
1Università degli studi dell'Aquila sede aggregata Chieti, Dept of Anaesthesiology & Intensive Care, L'Aquila, Italy. 2Università degli studi dell'Aquila, L'Aquila, Italy. 3Università degli studi dell’Aquila, Dept of Anaesthesiology & Intensive Care, L'Aquila, Italy. 4Ospedale Mazzini di Teramo, Dept of Anaesthesiology & Intensive Care, Teramo, Italy.  5 Ospedale S. Salvatore di L’Aquila Dept of Anaesthesiology & Intensive Care L'Aquila, Italy.

Diastolic Dysfunction (DD) is a known cause of heart failure, related to frequent systemic diseases in ICU patients; but the real prevalence of DD in ICU remains uncertain.
The aim of this prospective observational study is to investigate the prevalence of DD in a general ICU, and to value the relationship between DD and expected mortality (according to SAPS-2 score) and diagnosis on admission. All patients admitted to our ICU were part of the study, except patients whose recovery lasted less than 24h, patients with atrial fibrillation and patients with thoracic trauma. We collected anamnestic data, vital signs, SAPS-2 score and admission diagnosis. 4 TTE views (PSLAX, PSSAX, A4C, SC) were studied; a score was assigned to each view (2=optimal, 1=suboptimal, 0=unviewable) to identify the best one. Presence/absence of DD was studied through E/A transmitralic flow (presence if< 1); relationship between DD and hypertension, age, gender, expected mortality and admission diagnosis was analyzed. The differences between the two groups (presence/absence of DD) were analyzed with t-test, with χ2-test and fisher exact for categorical variables. Data were collected in an Excel® table and processed with a statistic package: STATA/IC 12.0. 
Our sample consisted of 110 patients, 64 males and 46 females, with an average age of 64,5 years. 59 patients had hypertension. Diagnoses on admission were multifactorial shock, cardiac arrest, respiratory failure, neurosurgical, polytrauma and septic shock. 59 patients (66,3%) had DD; DD resulted statistically related with hypertension (P=0.001) and old age (P< 0.0001), as already known in literature. Relation between DD and all the mentioned admission diagnosis, resulted statistically relevant (P=0.016). Expected mortality (P=0.087) and gender (P=0.49) resulted not statistically related to DD. The study also revealed that the best TTE view was A4C followed by PSLAX. 52,27% of our patients had at least 2 optimal views, only 5,45% had none.
To conclude, this study underlines that DD is a frequent cause of heart failure in ICU patients, related to old age, hypertension and diagnosis on admission. Identifing a DD is useful in terms of therapy and patient's outcome. The 2 main TTE views (PSLAX, A4C) are viewable also in mechanically ventilated and not mobilized patients; it allows obtaining a wide range of information about heart function. A bigger sample should be needed to study more detailed relations between DD, treatments and outcome.

Diastolic dysfunction in intensive care unit: a pilot study in the general intensive care unit of l’aquila - Italy