title: Diastolic dysfunction and mortality in septic patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  Myocardial dysfunction may contribute to the haemodynamic instability which accompanies sepsis, and may result in circulatory failure. There is no association between systolic dysfunction (SD) and mortality in septic patients and there is conflicting evidence regarding the effects of diastolic dysfunction (DD) on mortality in septic patients.
  
  
  METHODS
  We conducted a systematic review and meta-analysis to investigate DD and mortality in septic patients. We included studies conducted in this patient population which investigated the association between DD reported according to tissue Doppler imaging (TDI) criteria and mortality, using the longest reported follow-up. As a secondary endpoint, we evaluated the association between SD and mortality according to the results reported by the retrieved studies.
  
  
  RESULTS
  We included seven studies in our meta-analysis with 636 septic patients, 48% of them were found to have DD. We found a significant association between DD and mortality (RR 1.82, 95% CI 1.12-2.97, p = 0.02). This finding remained valid in a further analysis which including an older study reporting DD without TDI criteria. Five studies reported data on SD for a total of 581 patients, 29.6% of them with SD. No association was found between SD and mortality (RR 0.93, 95% CI 0.62-1.39, p = 0.73). Looking at subgroups, there was a trend towards higher mortality comparing isolated DD or combined SD-DD vs normal heart function (p = 0.10 and p = 0.05, respectively).
  
  
  CONCLUSIONS
  Diastolic dysfunction is common in septic patients and it is associated with mortality. Systolic dysfunction is less common and is not associated with mortality in this group of patients.
authors: Cardiothoracic Intensive Care Unit, Intensive Care Directorate-St Georges Healthcare NHS Trust, London, SW17 0QT, UK, filipposanfi@yahoo.it.
authors: Filippo
authors: F
authors: Sanfilippo
authors: Carlos
authors: C
authors: Corredor
authors: Nick
authors: N
authors: Fletcher
authors: Giora
authors: G
authors: Landesberg
authors: Umberto
authors: U
authors: Benedetto
authors: Pierre
authors: P
authors: Foex
authors: Maurizio
authors: M
authors: Cecconi
mesh_terms: D003971:Diastole / Q000502:physiology*; D054144:Heart Failure, Diastolic / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D018805:Sepsis / Q000401:mortality* / Q000503:physiopathology