Diastology in the intensive care unit: Challenges for the assessment and future directions

Myocardial dysfunction is common in patients admitted to the intensive care unit (ICU). Septic disease frequently results in cardiac dysfunction, and sepsis represents the most common cause of admission and death in the ICU. The association between left ventricular (LV) systolic dysfunction and mortality is not clear for critically ill patients. Conversely, LV diastolic dysfunction (DD) seems increasingly recognized as a factor associated with poor outcomes, not only in sepsis but also more generally in critically ill patients. Despite recent attempts to simplify the diagnosis and grading of DD, this remains relatively complex, with the need to use several echocardiographic parameters. Furthermore, the current guidelines have several intrinsic limitations when applied to the ICU setting. In this manuscript, we discuss the challenges in DD classification when applied to critically ill patients, the importance of left atrial pressure estimates for the management of patients in ICU, and whether the study of cardiac dysfunction spectrum during critical illness may benefit from the integration of left ventricular and left atrial strain data to improve diagnostic accuracy and implications for the treatment and prognosis. LV diastolic dysfunction is common in critically ill patients and is associated with poor outcomes. Echocardiography is used to assess LV diastolic function and estimate LV filling pressures. Recent American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines do not account for the specificities of the critically ill patient and are not validated in this population. LV and left atrial speckle tracking indices and artificial intelligence may provide better insight into the classification of DD in the critically ill.---- image