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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Sex differences in the prevalence of diastolic dysfunction in cardiac surgical patients
Renata G Ferreira1, Andrea Worthington, Chuan-Chin Huang
1Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
Insights
Female patients undergoing cardiac surgery show higher rates of diastolic dysfunction and prolonged hospital stays. This increased risk is more pronounced in older women, highlighting sex-based disparities in cardiac health outcomes.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Diastolic Heart Function
Background:
- Diastolic dysfunction carries significant mortality (9-28%).
- Female sex and advanced age are linked to increased ventricular diastolic stiffness in ischemic heart disease.
- Prior studies indicate higher diastolic dysfunction rates in women post-myocardial infarction, even with preserved ejection fractions.
Purpose of the Study:
- To investigate the hypothesis that female patients undergoing cardiac surgery exhibit greater diastolic dysfunction.
- To determine if female sex is associated with increased adverse outcomes, such as prolonged hospitalization, following cardiac surgery.
Main Methods:
- Prospective enrollment of 153 patients undergoing cardiac surgery.
- Assessment of diastolic function using early transmitral velocity (E) and early diastolic lateral mitral annular tissue velocity (e').
- Left ventricular diastolic dysfunction defined as a binary and continuous outcome (E/e' ratio).
Main Results:
- Females presented with significantly higher E/e' ratios (11.5 vs. 7.9, p=0.001) and diastolic dysfunction prevalence (71% vs. 36%, p<0.001) compared to males.
- Sex was a significant predictor for left ventricular diastolic dysfunction.
- The disparity in E/e' ratios between sexes was most pronounced in the 56-72-year-old age group.
Conclusions:
- Females exhibit a higher prevalence of diastolic dysfunction during elective cardiac surgery compared to males.
- The increased prevalence of diastolic dysfunction in females is more pronounced with advancing age.
- Female sex is associated with a higher risk of prolonged intensive care unit and hospital stays post-cardiac surgery.
Objectives:
The mortality from diastolic dysfunction is approximately 9% to 28%. In patients with ischemic heart disease, female sex and advanced age are associated with increases in ventricular diastolic stiffness. Clinical studies have found higher rates of diastolic dysfunction in women, despite higher ejection fractions, than in men post-myocardial infarction. Therefore, we hypothesized that female patients undergoing cardiac surgery have higher degrees of diastolic dysfunction and experience more adverse outcomes, such as prolonged hospitalization.
Methods:
We prospectively enrolled 153 patients undergoing cardiac surgery. Diastolic function was assessed using early transmitral velocity (E) and early diastolic lateral mitral annular tissue velocity (e'). Left ventricular diastolic dysfunction was defined as binary and a continuous outcome (E/e').
Results:
Females were more likely than males to present with higher E/e' (11.5 vs. 7.9, p = 0.001) and higher left ventricular diastolic dysfunction (71% vs. 36%, p < 0.001). The addition of sex to the model for left ventricular diastolic dysfunction was significant. The relationship between sex and E/e' ratio showed the biggest difference between males and females in the 56-72-year-old age brackets, where women were much more likely to have a higher E/e' than males.
Conclusions:
We identified a significantly higher prevalence of diastolic dysfunction among females presenting for elective cardiac surgery compared to males. This finding is more pronounced with age. Additionally, we found that female sex is at higher risk of prolonged ICU and hospital length of stay.
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