A Practical Approach to Echocardiographic Assessment of Perioperative Diastolic Dysfunction

Intraoperative Transesophageal Echocardiography: A Critical Appraisal of Its Current Role in the Assessment of Diastolic Dysfunction

“…4,19 Typical grading progresses from impaired relaxation, through pseudonormalization, to a restrictive filling pattern, each reflecting increasingly severe diastolic dysfunction (Table 3). 4,14,15,19,25,29 Guidelines for the echocardiographic assessment of diastolic function are based on data from large numbers of patients across a range of clinical contexts undergoing TTE. A demonstrated association between diastolic dysfunction graded by TTE and important outcomes, such as quality of life, development of heart failure and mortality, 4,30,31 supports the validity of this noninvasive method of assessment.…”

“…Classification of Diastolic Dysfunction (Modified from Redfield et al, 4 Mahmood et al, 14 Matyal et al, 15 Nagueh et al, 19 Lester et al, 25 and Swaminathan et al 29 ) of diastolic function, an integrated approach incorporating a combination of transmitral flow, pulmonary venous flow, tissue Doppler and transmitral flow propagation velocity to categorize patients within the context of ASE guidelines has been suggested as most appropriate for the intraoperative setting. 15 However, the feasibility of adequately and routinely attaining such a combination of modalities in the clinical context remains uncertain.…”

“…29 To date, at least 4 different algorithms have been proposed for the intraoperative grading of diastolic dysfunction. 14,15,29,51 While study-specific differences in algorithms may be rationally based on clinical context and study-specific needs, potential differences in classification (or misclassification) depending on choice of algorithm are likely significant, but remains unknown.…”

“…Current Society of Cardiovascular Anesthesiologists/American Society of Echocardiography (SCA/ASE) guidelines for performing a comprehensive TEE examination make little specific comment on the assessment of diastolic function, 13 and expert narrative reviews are conflicting as to whether such an assessment should be a routine component of a comprehensive intraoperative examination. 14,15 The aim of the current review is to critically assess the evidence for the intraoperative assessment of left ventricular diastolic function by TEE, identifying and highlighting important knowledge gaps and suggesting a research agenda to better define the role and limitations of intraoperative echocardiography for this purpose.…”

Transesophageal Monitoring in Anaesthesia: An Update

“…A simplified TEE algorithm for assessing LVDD using both e 0 and the E/e 0 ratio in CABG patients (n = 905) has been predictive of long-term major adverse cardiac events [18]. A practical approach to the assessment of LVDD involving LA size has also been proposed [19]. Simpler algorithms and robust indices are likely to see an increase in diagnosis of LVDD [20 •• ].…”