Diastolic failure in vascular surgery. A forgotten outcome predictor variable or not?

In vascular surgery, sometimes prediction of surgical outcome prior to surgery is next to impossible despite extensive history, requisite investigations and optimum perioperative management. It is well recognized that the leading cause of death in vascular surgery are cardiovascular events. Each surgeon remembers those patients sustaining morbidity and mortality despite the routine nature of surgery performed and the uncomplicated intraoperative course. In some patients the answer to the etiology regarding this observed poor outcome remains rhetorical and a mystery to be solved. Severity scores depend on the variables used, however if unknown recognized variables are not included, quality measurement of outcome in surgery becomes questionable. As surgeons become charged with evidence-based ideas, clinical observations will remain the child of updating both our own functional equations for outcome for ultimate improvement in patient care. Most patients with isolated diastolic dysfunction as the cause of their symptoms have hypertension or coronary artery disease or both (especially in the presence of renal dysfunction or diabetes mellitus) and can develop symptoms of heart failure in the absence of coronary obstructive picture. But could there be a way of approximating reality when predicting outcome?