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Diastolic dysfunction is common and predicts outcome after cardiac surgery

Thomas S Metkus1, Alejandro Suarez-Pierre2, Todd C Crawford2

  • 1Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524 D2, Baltimore, MD, 21287, USA. tmetkus1@jhmi.edu.

Journal of Cardiothoracic Surgery
|June 16, 2018
PubMed

Insights

Diastolic dysfunction (DD) is common after cardiac surgery and independently predicts worse outcomes. Early identification of DD using echocardiography can help manage patients undergoing procedures like coronary artery bypass grafting and aortic valve replacement.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Echocardiography

Background:

  • Diastolic dysfunction (DD) on echocardiography predicts mortality after cardiac surgery.
  • The utility of specific diastolic parameters and DD's association with adverse outcomes remain unclear.

Purpose of the Study:

  • To assess the association of preoperative diastolic dysfunction grade with mortality, prolonged mechanical ventilation, ICU readmission, and extended hospital stay after cardiac surgery.
  • To determine the most useful diastolic parameters for risk stratification.

Main Methods:

  • Retrospective analysis of 577 patients undergoing coronary artery bypass grafting (CABG), aortic valve replacement (AVR), or combined procedures (2010-2016).
  • Preoperative transthoracic echocardiography (TTE) assessed diastolic function using transmitral E/A waves and septal tissue Doppler velocity.
  • Logistic regression analyzed the association of DD grade with a composite endpoint of death, prolonged ventilation, ICU readmission, and hospital length of stay >14 days.

Main Results:

  • 42% of patients had grade II or III DD.
  • Increased DD grade and elevated LV filling pressures (E/e' ratio) correlated with higher rates of death and prolonged ventilation.
  • Both systolic (LVEF) and diastolic function independently predicted outcomes.

Conclusions:

  • Diastolic dysfunction is prevalent in cardiac surgery patients.
  • DD independently predicts adverse outcomes including death, prolonged ventilation, and extended hospital/ICU stays.
  • Echocardiographic assessment of diastolic function is crucial for risk stratification in cardiac surgery.
Abstract

Keywords:
AVRCABGDiastolic dysfunctionEchocardiographyMechanical ventilation

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