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[Diastolic dysfunction in cardiac surgery intensive care. Study methods, changes and prognosis]
1Istituto di Ricerca e Cura a Carattiere Scientifico, Ospedale San Raffaele, Milano.
Insights
Coronary artery bypass grafting (CABG) patients often have diastolic dysfunction, which typically resolves within three months post-surgery. This condition did not correlate with adverse outcomes in the intensive care unit (ICU).
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Diastolic dysfunction is common in patients with coronary artery disease.
- The natural history of diastolic dysfunction after coronary artery bypass grafting (CABG) is not well understood.
- Understanding diastolic dysfunction evolution post-CABG is crucial for predicting intensive care unit (ICU) prognosis.
Purpose of the Study:
- To determine the incidence and evolution of diastolic dysfunction in patients undergoing CABG.
- To investigate the correlation between diastolic dysfunction and adverse in-ICU outcomes.
- To assess the long-term recovery of diastolic function after CABG.
Main Methods:
- Eighty-eight patients with coronary artery disease and preserved left ventricular function scheduled for CABG were studied.
- Transesophageal Doppler echocardiography (TEE) assessed mitral and pulmonary venous flow pre- and post-bypass, on ICU arrival, and at 3 months.
- Diastolic dysfunction was categorized as mild, moderate, or severe; adverse ICU events included prolonged stay, inotropic support, perioperative myocardial infarction, and death.
Main Results:
- Baseline diastolic dysfunction was present in 77% of patients.
- Diastolic function did not significantly worsen after cardiopulmonary bypass and reperfusion.
- Diastolic dysfunction resolved in 85% of patients by 3 months post-CABG and was not associated with adverse ICU outcomes (18% vs. 13%, p=ns).
Conclusions:
- Reduced diastolic function is prevalent in patients undergoing CABG but typically resolves within 3 months.
- Diastolic dysfunction following CABG does not appear to predict adverse outcomes in the ICU.
- TEE is a valuable tool for monitoring diastolic function changes after cardiac surgery.
Abstract:
The natural history of patients with coronary artery disease and diastolic dysfunction who underwent coronary artery bypass grafting (CABG) is not well known. The aims of our study were to evaluate the incidence of diastolic dysfunction, its evolution after CABG and its possible correlation with adverse in-ICU prognosis. We studied 88 consecutive patients scheduled for CABG with not severely depressed left ventricular function (ejection fraction > 35%) and multivessels disease. Buckberg cardioplegia was used for myocardial protection. Diastolic function was investigated by recording mitral and venous pulmonary flow by transesophageal Doppler echocardiography (TEE). TEE examination was performed in operative room pre and post-bypass, at ICU arrival and after three months. Diastolic dysfunction was defined as mild, moderate and severe. Adverse in ICU events were defined as: use of inotropic drugs or ventricular mechanical support, an ICU stay > 24 hours, perioperative myocardial infarction and death. The study group was compared with a control group. T-Student test was used; a p < 0.05 was considered significant. A reduced diastolic function was present in 77% of patients at baseline examination. Diastolic dysfunction did not worsen significantly after hypothermic cardiac arrest and reperfusion. It persisted during ICU stay and normalized after three months from CABG in the majority of patients (85%). Diastolic failure was not associated with an adverse ICU prognosis (adverse events: 18 versus 13%; p = ns).