Diastolic function: a barometer for cardiovascular risk?

Abstract

Perioperative cardiovascular risk assessment has undergone significant advances, including development and validation of multivariable risk indices for prediction of major cardiac complications,1–3 advances in detecting ischemic heart disease, and noninvasive detection of symptomatic reductions in left ventricular (LV) ejection fraction.4 However, we have recently recognized that current preoperative assessments may fail to fully appreciate a patient's vulnerability after major noncardiac surgery because early and late cardiac events can occur in the absence of coronary artery disease or heart failure symptoms.5–7 In this issue of Anesthesiology, Flu and colleagues8 extend these findings, identifying the impact that subclinical LV systolic and diastolic dysfunction (DD) has on postoperative outcomes in patients undergoing open vascular or endovascular surgery. As the current American College of Cardiology/American Heart Association perioperative guidelines fall short in discussing the clinical implications of DD, a closer look at this disorder is warranted.