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Managing Diastolic Dysfunction Perioperatively
Theodore J Cios1, John C Klick2, S Michael Roberts1
1Department of Anesthesiology and Perioperative Medicine, 12311Penn State Hershey Medical Center, Hershey, PA, USA.
Insights
Preoperative cardiac evaluation should assess diastolic function, not just systolic function, as diastolic heart failure independently predicts mortality. This review covers its perioperative relevance and management.
Area of Science:
- Anesthesiology
- Cardiology
- Perioperative Medicine
Background:
- Preoperative cardiac evaluation is crucial in anesthesiology.
- Focus is often on systolic function (ejection fraction) and valvular disease.
- Diastolic dysfunction, a predictor of mortality, is frequently overlooked.
Purpose of the Study:
- To review the clinical relevance of diastolic dysfunction in the perioperative setting.
- To discuss management strategies for perioperative diastolic dysfunction.
Main Methods:
- This is a narrative review.
- Literature search on preoperative cardiac evaluation, diastolic dysfunction, and perioperative outcomes.
Main Results:
- Diastolic heart failure is an independent predictor of mortality.
- Diastolic dysfunction can occur in patients with normal systolic function.
- Echocardiography may be indicated even with adequate functional capacity if diastolic dysfunction is suspected.
Conclusions:
- Diastolic function assessment is critical in preoperative cardiac evaluation.
- Perioperative management should consider diastolic dysfunction to improve patient outcomes.
- Further research into optimizing perioperative care for patients with diastolic dysfunction is warranted.
Abstract:
Preoperative cardiac evaluation is a cornerstone of the practice of anesthesiology. This consists of a thorough history and physical attempting to elucidate signs and symptoms of heart failure, angina or anginal equivalents, and valvular heart disease. Current guidelines rarely recommend preoperative echocardiography in the setting of an adequate functional capacity. Many patients may have poor functional capacity and/or have medical history such that echocardiographic data is available for review. Much focus is often placed on evaluating major valvular abnormalities and systolic function as measured by ejection fraction, but a key impactful component is often overlooked-diastolic function. A diagnosis of diastolic heart failure is an independent predictor of mortality and is not uncommon in patients with normal systolic function. This narrative review addresses the clinical relevance and management of diastolic dysfunction in the perioperative setting.
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