Diastolic dysfunction is common and predicts outcome after cardiac surgery
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RESEARCH ARTICLE
Open Access
Diastolic dysfunction is common and predicts outcome after cardiac surgery Thomas S. Metkus1* , Alejandro Suarez-Pierre2, Todd C. Crawford2, Jennifer S. Lawton2, Lee Goeddel3, Jeffrey Dodd-o3, Monica Mukherjee1, Theodore P. Abraham4 and Glenn J. Whitman2
Abstract Background: Diastolic dysfunction (DD) identified on echocardiography predicts mortality after cardiac surgery, however the most useful diastolic parameters for assessment and the association of DD with prolonged mechanical ventilation, ICU re-admission, and hospital length of stay are not established. Methods: We included patients that underwent coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or a combined procedure (CAB-AVR) from 2010 to 2016, and who had preoperative transthoracic echocardiography (TTE) at our institution within 6 months of the operation. Diastolic function was graded using the transmitral E and A waves and the septal tissue Doppler velocity. We performed logistic regression to assess the association of grade of DD with a composite endpoint of death, prolonged mechanical ventilation, ICU readmission during hospitalization, and hospital length of stay longer than 14 days. Results: Between 2010 and 2016, 577 patients were eligible for inclusion. DD was common, with 42% of the cohort manifesting grade II or grade III DD. Rates of death and prolonged ventilation increased across grades of DD and across quartiles of increasing LV filling pressure, assessed by the E/e’ ratio. Adjusting for age, sex, procedure, systolic and diastolic function, both systolic (odds ratio 0.68 95% CI 0.55–0.85 per inter-quartile increase in LVEF) and diastolic function (odds ratio 1.31 95% CI 1.04–1.66 per increasing DD grade) both independently predicted outcome. Conclusion: Diastolic dysfunction is common among patients undergoing cardiac surgery and is associated with death, prolonged mechanical ventilation, and prolonged hospital and ICU length of stay independent of systolic dysfunction. Keywords: CABG, AVR, Echocardiography, Diastolic dysfunction, Mechanical ventilation
Background Diastolic dysfunction (DD) consists of abnormalities in myocardial relaxation and increased left ventricular stiffness leading to elevated cardiac filling pressures and, in the extreme form, decreased stroke volume [1, 2]. DD is a cardinal manifestation of heart failure with preserved ejection fraction (HFpEF) [3] and is impacted by volume status [4], positive pressure ventilation [5–7], and revascularization [8]. Diastolic function assessed by echocardiography has been shown to be associated with atrial fibrillation after cardiac surgery in some [9] but not all [10] studies, and various echocardiographic markers of diastolic function may predict outcomes including death, * Correspondence: [email protected] 1 Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524 D2, Baltimore, MD 21287, USA Full list of author information is available at the end of the article
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