Diastolic dysfunction and mortality in severe sepsis and septic shock

Giora Landesberg*, Dan Gilon, Yuval Meroz, Milena Georgieva, Phillip D. Levin, Sergey Goodman, Alexander Avidan, Ronen Beeri, Charles Weissman, Allan S. Jaffe, Charles L. Sprung

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

325 Scopus citations


Aims: Systolic dysfunction in septic shock is well recognized and, paradoxically, predicts better outcome. In contrast, diastolic dysfunction is often ignored and its role in determining early mortality from sepsis has not been adequately investigated. Methods and results: A cohort of 262 intensive care unit patients with severe sepsis or septic shock underwent two echocardiography examinations early in the course of their disease. All clinical, laboratory, and survival data were prospectively collected. Ninety-five (36%) patients died in the hospital. Reduced mitral annular e′-wave was the strongest predictor of mortality, even after adjusting for the APACHE-II score, low urine output, low left ventricular stroke volume index, and lowest oxygen saturation, the other independent predictors of mortality (Cox's proportional hazards: Wald = 21.5, 16.3, 9.91, 7.0 and 6.6, P< 0.0001, <0.0001, 0.002, 0.008, and 0.010, respectively). Patients with systolic dysfunction only (left ventricular ejection fraction ≤50%), diastolic dysfunction only (e′-wave <8 cm/s), or combined systolic and diastolic dysfunction (9.1, 40.4, and 14.1% of the patients, respectively) had higher mortality than those with no diastolic or systolic dysfunction (hazard ratio = 2.9, 6.0, 6.2, P = 0.035, <0.0001, <0.0001, respectively) and had significantly higher serum levels of high-sensitivity troponin-T and N-terminal pro-B-type natriuretic peptide (NT-proBNP). High-sensitivity troponin-T was only minimally elevated, whereas serum levels of NT-proBNP were markedly elevated [median (inter-quartile range): 0.07 (0.02-0.17) ng/mL and 5762 (1001-15 962) pg/mL, respectively], though both predicted mortality even after adjusting for highest creatinine levels (Wald = 5.8, 21.4 and 2.3, P = 0.015, <0.001 and 0.13). Conclusion: Diastolic dysfunction is common and is a major predictor of mortality in severe sepsis and septic shock. Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageAmerican English
Pages (from-to)895-903
Number of pages9
JournalEuropean Heart Journal
Issue number7
StatePublished - Apr 2012
Externally publishedYes

Bibliographical note

Funding Information:
The study was funded in part by a grant from the International Anesthesia Research Society (IARS) and in part by a grant from Hadassah Hospital.


  • Diastolic dysfunction
  • Echocardiography
  • Heart failure with normal ejection fraction
  • Mortality
  • Sepsis


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