Diastolic dysfunction is common and predicts outcome after cardiac surgery

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.