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Published on: November 28, 2018
A practical approach to echocardiographic assessment of perioperative diastolic dysfunction
Feroze Mahmood1, Jayant Jainandunsing, Robina Matyal
1Beth Israel Deaconess Medical Center, Boston, MA, USA. fmahmood@bidmc.harvard.edu
Insights
Diastolic dysfunction (DD) assessment is often omitted during surgery. This study proposes a simplified Doppler algorithm for perioperative DD diagnosis, aiming to guide treatment and improve patient outcomes.
Area of Science:
- Cardiology
- Anesthesiology
- Echocardiography
Background:
- Doppler assessment of diastolic dysfunction (DD) is not routinely included in intraoperative echocardiography.
- Lack of a simplified perioperative algorithm, unclear clinical implications, and limited therapeutic options contribute to its infrequent use.
Purpose of the Study:
- To address reasons for the infrequent use of Doppler indices for perioperative DD assessment.
- To propose a simplified, mechanistic algorithm for diagnosing perioperative DD based on published guidelines.
- To facilitate routine application of Doppler assessment for improved patient therapy and outcomes.
Main Methods:
- Review of common conceptual questions regarding perioperative DD assessment raised by anesthesiologists.
- Development of a simplified algorithm for Doppler assessment of DD.
- Integration of left atrial size as a marker for elevated left ventricular end-diastolic pressure and risk stratification.
Main Results:
- A simplified algorithm for perioperative Doppler assessment of diastolic dysfunction is proposed.
- The algorithm aims for routine clinical application to influence therapeutic decisions.
- Left atrial size is suggested as a valuable marker for risk stratification.
Conclusions:
- A simplified Doppler algorithm can aid in the routine assessment and diagnosis of perioperative diastolic dysfunction.
- This approach may lead to improved therapeutic strategies and patient outcomes.
- Left atrial size measurement is a useful adjunct for risk stratification in patients with potential diastolic dysfunction.
Abstract:
The Doppler assessment of diastolic dysfunction (DD) is not part of a standard comprehensive intraoperative echocardiographic examination. Although the reasons may be many, the lack of a simplified algorithm for the assessment of DD specific to the perioperative arena, the implications of this diagnosis on clinical care, and the absence of therapeutic options are some of the commonly cited reasons. In this article, the authors address these possible reasons for the lack of routine application of Doppler indices to assess perioperative DD. The authors have chosen to highlight some of the most common conceptual questions, which often have been raised by anesthesiologists, and attempted to suggest answers. Drawing from their experience and data, the authors propose a simplified algorithm for the application of Doppler to assess and diagnose DD with an individualized and a mechanistic approach. The proposed algorithm is from within the premise of the published guidelines and attempts to simplify the perioperative approach. The authors hope this approach will be simple enough for routine application to affect therapy and a tangible change in outcome. The authors suggest that knowledge of left atrial size is valuable as a marker for persistently increased left ventricular end-diastolic pressure and its possible role in risk stratification.
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