Consensus Defined Diastolic Dysfunction and Cardiac Postoperative Morbidity Score: A Prospective Observational Study.

Bonnie Kyle,Ashraf Hamarneh,Hilary Shanahan,Andrew Rogers,Mateusz Zawadka,Andrew Smith,Vivek Sivaraman,Sibtain Anwar,Jackie Cooper

doi:10.3390/jcm10215198

Abstract

Diastolic dysfunction is associated with major adverse outcomes following cardiac surgery. We hypothesized that multisystem endpoints of morbidity would be higher in patients with diastolic dysfunction. A total of 142 patients undergoing cardiac surgical procedures with cardiopulmonary bypass were included in the study. Intraoperative assessments of diastolic function according to the 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines using transesophageal echocardiography were performed. Cardiac Postoperative Morbidity Score (CPOMS) on days 3, 5, 8, and 15; length of stay in ICU and hospital; duration of intubation; incidence of new atrial fibrillation; 30-day major adverse cardiac and cerebrovascular events were recorded. Diastolic function was determinable in 96.7% of the dataset pre and poststernotomy assessment (n = 240). Diastolic dysfunction was present in 70.9% (n = 88) of measurements before sternotomy and 75% (n = 93) after sternal closure. Diastolic dysfunction at either stage was associated with greater CPOMS on D5 (p = 0.009) and D8 (p = 0.009), with CPOMS scores 1.24 (p = 0.01) higher than in patients with normal function. Diastolic dysfunction was also associated with longer durations of intubation (p = 0.001), ICU length of stay (p = 0.019), and new postoperative atrial fibrillation (p = 0.016, OR (95% CI) = 4.50 (1.22–25.17)). We were able to apply the updated ASE/EACVI guidelines and grade diastolic dysfunction in the majority of patients. Any grade of diastolic dysfunction was associated with greater all-cause morbidity, compared with patients with normal diastolic function.

Highlights

Cardiac Postoperative Morbidity Score (CPOMS) was observed to increase by approximately one point with each stepwise increase from normal diastolic function, to diastolic dysfunction with normal left atrial pressure, to diastolic dysfunction with raised left atrial pressure in both presternotomy and poststernal closure groups
This study demonstrated that any grade of diastolic dysfunction was associated with greater all-cause morbidity, compared with patients with normal diastolic function
We identified the presence of perioperative diastolic dysfunction in 77.4% of our dataset, which is in line with that previously described in a coronary artery bypass grafting (CABG) population [2,28]

Summary

Introduction

Diastolic dysfunction refers to the inability of the ventricle to relax to its original unstressed state [1]. It is present in up to 50% of elderly patients [2,3] in the setting of cardiac surgery. Diastolic dysfunction is associated with major adverse cardiovascular events [4,5], respiratory complications, and length of stay after cardiac surgery and inhospital mortality [6,7] and is an independent predictor of major adverse outcomes after vascular [8] and noncardiac surgery [9,10].

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Discussion

Conclusion