Abstract
Radical cystectomy, which is a standard treatment of muscle invasive and high-grade non-invasive bladder tumour, is accompanied with high rates of postoperative complications including major adverse cardiac events (MACE). Diastolic dysfunction is associated with postoperative complications. We evaluated perioperative risk factors including diastolic dysfunction related with MACE within 6 months after radical cystectomy. The 546 patients who underwent elective radical cystectomy were included. Diastolic dysfunction was defined as early transmitral flow velocity (E)/early diastolic mitral annulus velocity (e′) > 15. Logistic regression analysis, Kaplan-Meier survival analysis and log-rank test were performed. MACE within 6 months after radical cystectomy developed in 43 (7.9%) patients. MACE was related with female (odds ratio 2.546, 95% confidence interval 1.166–5.557, P = 0.019) and diastolic dysfunction (odds ratio 3.077, 95% confidence interval 1.147–8.252, P = 0.026). The 6-month mortality were significantly higher in the MACE group, and hospital stay and intensive care unit stay were significantly longer in the MACE group compared to the non-MACE group. Accordingly, preoperative diastolic dysfunction (E/e′ > 15) was related with postoperative MACE and MACE was related with 6-month survival after radical cystectomy. These results suggest that preoperative diastolic dysfunction can provide useful information on postoperative complications.
Highlights
Radical cystectomy is regarded as a standard treatment in patients with muscle invasive and high-grade non-invasive bladder tumour[1,2]
The major findings in this study showed that preoperative diastolic dysfunction (E/e′ > 15) and female gender were related with major adverse cardiac events (MACE) within 6 months after radical cystectomy in bladder cancer patients
Postoperative MACE was related with 6-month survival after radical cystectomy
Summary
Radical cystectomy is regarded as a standard treatment in patients with muscle invasive and high-grade non-invasive bladder tumour[1,2]. Radical cystectomy is classified as a major operative procedure and is accompanied with high postoperative complication rates among urological operations. Sustained increase in left ventricular filling pressure can be intolerable in volume adjustment and is associated with perioperative cardiac events[8]. In this regard, diastolic dysfunction may demonstrate on primary cardiac events[9]. The prognostic role of diastolic dysfunction as a preoperative risk factor of postoperative major adverse cardiac events (MACE) in patients undergoing radical cystectomy has not been clearly explained. In the present study, we aimed to evaluate independent risk factors including diastolic dysfunction related with MACE within 6 months following radical cystectomy in bladder cancer patients. Intensive care unit stay and hospital stay were compared between MACE group (patients who developed MACE) and non-MACE group (those who did not)
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