Grade 3 Echocardiographic Diastolic Dysfunction Is Associated With Increased Risk of Major Adverse Cardiovascular Events After Surgery: A Retrospective Cohort Study

Zhou, Yan; Liu, Lin; Cheng, Tong; Wang, Dong‐Xin; Yang, Hong‐Yun; Zhang, Baowei; Yang, Ying; Chen, Feng; Li, Xueying

doi:10.1213/ane.0000000000003807

Cited by 16 publications

(9 citation statements)

References 27 publications

(32 reference statements)

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“…DD-related echocardiographic variables have been associated with postoperative MACE and mortality in noncardiac and nonhepatic surgery. [20][21][22][23][24][25] Of these variables, those relating to left ventricular filling pressure (septal e', lateral e', E/e' ratio) have all been implicated as the most important variables in this regard. [23,26,27,28] Impairments in these measurements have also been correlated with heart failure after LT, likely as sequela of structural abnormalities of the myocardium.…”

Section: Discussionmentioning

confidence: 99%

Cirrhotic cardiomyopathy: Appraisal of the original and revised criteria in predicting posttransplant cardiac outcomes

et al. 2022

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Cardiovascular disease (CVD) significantly contributes to morbidity and mortality after liver transplantation (LT). Cirrhotic cardiomyopathy (CCM) is a risk factor for CVD after transplant. CCM criteria were originally introduced in 2005 with a revision proposed in 2020 reflecting echocardiographic technology advancements. This study assesses the two criteria sets in predicting major adverse cardiac events (MACE) after transplant. This single‐center retrospective study reviewed adult LT recipients between January 1, 2009, and December 31, 2018. Patients with insufficient pre‐LT echocardiographic data, prior ischemic heart disease, portopulmonary hypertension, or longitudinal care elsewhere were excluded. The primary composite outcome was MACE (arrhythmia, heart failure, cardiac arrest, and/or cardiac death) after transplant. Of 1165 patients, 210 met the eligibility criteria. CCM was present in 162 patients (77%) per the original criteria and 64 patients (30%) per the revised criteria. There were 44 MACE and 31 deaths in the study period. Of the deaths, 38.7% occurred secondary to CVD. CCM defined by the original criteria was not associated with MACE after LT (p = 0.21), but the revised definition was significantly associated with MACE (hazard ratio [HR], 1.93; 95% confidence interval, 1.05–3.56; p = 0.04) on multivariable analysis. Echocardiographic variable analysis demonstrated low septal e’ as the most predictive variable for MACE after LT (HR, 3.45; p < 0.001). CCM, only when defined by the revised criteria, was associated with increased risk for MACE after LT, validating the recently revised CCM definition. Abnormal septal e’, reflecting impaired relaxation, appears to be the most predictive echocardiographic criterion for MACE after LT.

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Section: Discussionmentioning

confidence: 99%

Cirrhotic cardiomyopathy: Appraisal of the original and revised criteria in predicting posttransplant cardiac outcomes

et al. 2022

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“…the association of diastolic dysfunction with post-operative adverse events, including pulmonary oedema, AF, and mortality. [134][135][136][137][138] A meta-analysis including 3876 patients undergoing NCS found preoperative diastolic dysfunction to be an independent risk factor for pulmonary oedema, congestive HF, and MI after surgery. 139 However, a recent retrospective study, including 7312 patients, showed no association between the degree of diastolic dysfunction and in-hospital mortality or hospital length of stay in NCS patients.…”

Section: Resting Transthoracic Echocardiographymentioning

confidence: 99%

2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

Halvorsen¹,

Mehilli²,

Cassese³

et al. 2022

European Heart Journal

484

200

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All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and simultaneously published in a supplementary document to the guidelines. The report is also available on the ESC website www.escardio.org/Guidelines See the European Heart Journal online for supplementary data that include background information and detailed discussion of the data that have provided the basis of the guidelines.Click here to access the corresponding ESC CardioMed chapters.

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“…The time needed for tissue Doppler measurements in the point-of-care context is within one minute, as shown in our previous study. [23] Diastolic dysfunction is initially often asymptomatic, but is still associated with an increased morbidity and all-cause mortality [2], adverse surgical outcome [4][5][6]27] and mortality in septic patients. [28,29] On the other side, in a recently published retrospective study on the prevalence of diastolic dysfunction and postoperative outcomes, no signi cant association was found between diastolic dysfunction and in-hospital mortality or acute kidney injury.…”

Section: Discussionmentioning

confidence: 99%

Pre-Operative Point-of-Care Assessment of Left Ventricular Diastolic Dysfunction, an Observational Study

Stenberg

Rhodin

Lindberg

et al. 2022

Preprint

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Background Left ventricular (LV) diastolic dysfunction is an acknowledged peri-operative risk factor that should be identified before surgery. This study aimed to evaluate a simplified echocardiographic method using e’ and E/e’ for identification and grading of diastolic dysfunction pre-operatively. Methods 96 ambulatory surgical patients were consecutively included to this prospective observational study. Pre-operative transthoracic echocardiography was conducted prior to surgery, and diagnosis of LV diastolic dysfunction was established by comprehensive and simplified assessment, and the results were compared. The accuracy of e’-velocities in order to discriminate patients with diastolic dysfunction was established by calculating accuracy, efficiency, positive (PPV) and negative predictive (NPV) values, and area under the receiver operating characteristic curve (AUROC). Results Comprehensive assessment established diastolic dysfunction in 77% (74/96) of patients. Of these, 22/74 was categorized as mild dysfunction, 43/74 as moderate dysfunction and 9/74 as severe dysfunction. Using the simplified method with e’ and E/e’, diastolic dysfunction was established in 70.8% (68/96) of patients. Of these, 8/68 was categorized as mild dysfunction, 36/68 as moderate dysfunction and 24/68 as severe dysfunction. To discriminate diastolic dysfunction of any grade, e’-velocities (mean<9 cm s−1) had an AUROC of 0.901 (95%CI 0.840-0.962), with a PPV of 55.2%, a NPV of 90.9% and a test efficiency of 0.78. Conclusions The results of this study indicate that a simplified approach with tissue Doppler e’-velocities may be used to rule out patients with diastolic dysfunction pre-operatively, but together with E/e’ ratio the severity of diastolic dysfunction may be overestimated. Trial registration: Clinicaltrials.gov, Identifier: NCT 03349593. Date of registration 2017-11-21. https://clinicaltrials.gov.

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Grade 3 Echocardiographic Diastolic Dysfunction Is Associated With Increased Risk of Major Adverse Cardiovascular Events After Surgery: A Retrospective Cohort Study

Cited by 16 publications

References 27 publications

Cirrhotic cardiomyopathy: Appraisal of the original and revised criteria in predicting posttransplant cardiac outcomes

Cirrhotic cardiomyopathy: Appraisal of the original and revised criteria in predicting posttransplant cardiac outcomes

2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

Pre-Operative Point-of-Care Assessment of Left Ventricular Diastolic Dysfunction, an Observational Study

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