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Full list of author information is available at the end of the articlethe multiple organ dysfunction syndrome, an often fatal sequela of severe sepsis and septic shock. Al-though most research on cardiovascular dysfunction in septic shock has focused on left ventricular (LV) sys-tolic dysfunction [1-5], LV diastolic dysfunction also occurs [6,7]. In sepsis, cardiac dysfunction reflects both intrinsic dysfunction and the adequacy of loading more sensitive to volume expansion interventions, often termed fluid resuscitation and often guided by central venous pressure (CVP). This sensitivity to re-suscitation may be particularly prominent among patients with more severe LV diastolic dysfunction, which is generally associated with elevated left-sided filling pressures. LV diastolic function is traditionally classified into four grades (Figure 1) primarily using spectral Doppler of mitral inflow and tissue Doppler of the mitral annu-lus. In normal diastolic physiology, blood flow into th