Perioperative Diastolic Dysfunction in Patients Undergoing Noncardiac Surgery Is an Independent Risk Factor for
Ashraf Fayad1, Mohammed T Ansari, Homer Yang
1From the Department of Anesthesiology, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada (A.F., H.Y.); School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada (M.T.A.); Department of Cardiology and Nuclear Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (T.R.); and Department of Epidemiology and Community Medicine, Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (G.A.W.).
Insights
Perioperative diastolic dysfunction (PDD) is a significant risk factor for adverse cardiovascular events after noncardiac surgery. This finding, based on moderate certainty evidence, highlights the need to consider PDD in surgical risk assessment.
Area of Science:
- Cardiology
- Anesthesiology
- Cardiovascular Surgery
Background:
- The prognostic significance of perioperative diastolic dysfunction (PDD) in noncardiac surgery is not well-established.
- Current guidelines do not recognize PDD as a perioperative risk factor.
Purpose of the Study:
- To systematically review and synthesize evidence on whether PDD independently predicts adverse events after noncardiac surgery.
Main Methods:
- A comprehensive search of multiple databases (Ovid MEDLINE, PubMed, EMBASE, Cochrane Library, Google) was conducted for English-language studies published up to April 2015.
- Seventeen studies involving 3,876 patients were included, with 13 contributing to meta-analysis.
- Risk of bias was assessed, and a random-effects model was used for meta-analysis; certainty of evidence was graded.
Main Results:
- PDD was significantly associated with pulmonary edema/congestive heart failure (OR, 3.90), myocardial infarction (OR, 1.74), and major adverse cardiovascular events (OR, 2.03).
- Higher long-term cardiovascular mortality was observed in patients undergoing open vascular repair (OR, 3.00).
- The overall certainty of the evidence was rated as moderate.
Conclusions:
- Moderate certainty evidence suggests that PDD is an independent risk factor for adverse cardiovascular outcomes following noncardiac surgery.
Background:
The prognostic value of perioperative diastolic dysfunction (PDD) in patients undergoing noncardiac surgery remains uncertain, and the current guidelines do not recognize PDD as a perioperative risk factor. This systematic review aimed to investigate whether existing evidence supports PDD as an independent predictor of adverse events after noncardiac surgery.
Methods:
Ovid MEDLINE, PubMed, EMBASE, the Cochrane Library, and Google search engine were searched for English-language citations in April 2015 investigating PDD as a risk factor for perioperative adverse events in adult patients undergoing noncardiac surgery. Two reviewers independently assessed the study risk of bias. Extracted data were verified. Random-effects model was used for meta-analysis, and reviewers' certainty was graded.
Results:
Seventeen studies met eligibility criteria; however, 13 contributed to evidence synthesis. The entire body of evidence addressing the research question was based on a total of 3,876 patients. PDD was significantly associated with pulmonary edema/congestive heart failure (odds ratio [OR], 3.90; 95% CI, 2.23 to 6.83; 3 studies; 996 patients), myocardial infarction (OR, 1.74; 95% CI, 1.14 to 2.67; 3 studies; 717 patients), and the composite outcome of major adverse cardiovascular events (OR, 2.03; 95% CI, 1.24 to 3.32; 4 studies; 1,814 patients). Evidence addressing other outcomes had low statistical power, but higher long-term cardiovascular mortality was observed in patients undergoing open vascular repair (OR, 3.00; 95% CI, 1.50 to 6.00). Reviewers' overall certainty of the evidence was moderate.
Conclusion:
Evidence of moderate certainty indicates that PDD is an independent risk factor for adverse cardiovascular outcomes after noncardiac surgery.
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