Preoperative Left Ventricular Diastolic Dysfunction Research Articles

Evaluation of left ventricular function after coronary artery bypass graft surgery in patients with type 2 diabetes

Objectives: Study factors affecting the change of left ventricular function after CABG in patients with type 2 diabetes at Ha Noi heart hospital from 8/2021 to 8 /2022. Subjects and methods: a cross-sectionnal observational study in 46 patients with type 2 diabetes and coronary artery bypass graft surgery from 8/2021 to 8/2022 at Hanoi Heart Hospital. Results: Mean age 66±8.73; the male/female ratio is 2.83/1; 43.5% of patients smoked; 65.2% had dyslipidemia; non STEMI accounted for 41%. 100% of patients had anterior interventricular artery damage and elective surgery accounted for 80.4% of patients. Echocardiographic results: The rate of regional movement disorders before and 6 months after surgery is 56.5% and 30%; the number of disturbance areas before and after surgery were 3.52±5.39 and 1.84±4.18, EF 6 months before and after surgery was 55,33 ± 11,49% and 59,13,98 ± 10,05%, respectively. 39%. The percentage of patients with EF improved after 6 months of surgery accounted for 52%, patients with unchanged EF accounted for 28%, 20% of patients with EF decreased after 6 months of surgery, on univariate analysis: Preoperative ejection fraction, regional movement disorder and preoperative left ventricular diastolic dysfunction are factors associated with the change of left ventricular function after surgery. On multivariate analysis: Preoperative ejection fraction was an independent predictor of improvement in postoperative ejection fraction. Conclusion: Preoperative ejection fraction, regional movement disorder and preoperative left ventricular diastolic dysfunction are factors related to the change of left ventricular function after surgery, among which preoperative ejection fraction was an independent predictor of postoperative improvement in ejection fraction.

Baseline Intraoperative Left Ventricular Diastolic Function Is Associated with Postoperative Atrial Fibrillation after Cardiac Surgery.

Detailed understanding of the association between intraoperative left atrial and left ventricular diastolic function and postoperative atrial fibrillation is lacking. In this post hoc analysis of the Posterior Left Pericardiotomy for the Prevention of Atrial Fibrillation after Cardiac Surgery (PALACS) trial, we aimed to evaluate the association of intraoperative left atrial and left ventricular diastolic function as assessed by transesophageal echocardiography (TEE) with postoperative atrial fibrillation. PALACS patients with available intraoperative TEE data (n = 402 of 420; 95.7%) were included in this cohort study. We tested the hypotheses that preoperative left atrial size and function, left ventricular diastolic function, and their intraoperative changes were associated with postoperative atrial fibrillation. Normal left ventricular diastolic function was graded as 0 and with lateral e' velocity 10 cm/s or greater. Diastolic dysfunction was defined as lateral e' less than 10 cm/s using E/e' cutoffs of grade 1, E/e' 8 or less; grade, 2 E/e' 9 to 12; and grade 3, E/e' 13 or greater, along with two criteria based on mitral inflow and pulmonary wave flow velocities. A total of 230 of 402 patients (57.2%) had intraoperative diastolic dysfunction. Posterior pericardiotomy intervention was not significantly different between the two groups. A total of 99 of 402 patients (24.6%) developed postoperative atrial fibrillation. Patients who developed postoperative atrial fibrillation more frequently had abnormal left ventricular diastolic function compared to patients who did not develop postoperative atrial fibrillation (75.0% [n = 161 of 303] vs. 57.5% [n = 69 of 99]; P = 0.004). Of the left atrial size and function parameters, only delta left atrial area, defined as presternotomy minus post-chest closure measurement, was significantly different in the no postoperative atrial fibrillation versus postoperative atrial fibrillation groups on univariate analysis (-2.1 cm2 [interquartile range, -5.1 to 1.0] vs. 0.1 [interquartile range, -4.0 to 4.8]; P = 0.028). At multivariable analysis, baseline abnormal left ventricular diastolic function (odds ratio, 2.02; 95% CI, 1.15 to 3.63; P = 0.016) and pericardiotomy intervention (odds ratio, 0.46; 95% CI, 0.27 to 0.78, P = 0.004) were the only covariates independently associated with postoperative atrial fibrillation. Baseline preoperative left ventricular diastolic dysfunction on TEE, not left atrial size or function, is independently associated with postoperative atrial fibrillation. Further studies are needed to test if interventions aimed at optimizing intraoperative left ventricular diastolic function during cardiac surgery may reduce the risk of postoperative atrial fibrillation.

Adverse Events After Surgical Myocardial Revascularization in Patients With Preoperative Left Ventricular Diastolic Dysfunction

Background: A significant number of patients who underwent surgical myocardial revascularization (CABG) have various comorbidities, including left ventricular diastolic dysfunction (LVDD). Objective: The aim of this paper is to show that patients with preoperative LVDD are at an increased risk of postoperative adverse events and have a worse prognosis compared to patients without LVDD. Methods: The study included 116 patients who underwent myocardial revascularization (CABG) performed at Medical Institute Bayer in Tuzla over a period of 1 year. None of the patients had previously undergone CABG or valvular surgery, or undergone stent implantation (PCI). The presence of LV diastolic dysfunction was detected by echocardiography, and the patients were divided into two groups: with and without LVDD, and further classified into three degrees of LVDD. Results: Of the total number of subjects who underwent surgical revascularization of the myocardium without echocardiographically detected LVDD, 24.1% were patients, and 75.9% were patients with LVDD. In the group with LVDD, the range of days spent in the intensive care unit (ICU) is significantly higher compared to patients without LVDD. Also, patients with LVDD had a significantly higher number of hours of inotropic support, a significantly higher number of cases of tachycardia, predominantly atrial fibrillation (POAF). In this group of patients, a greater number of other adverse events were observed, such as myocardial infarction, cardiac or renal failure, TIA or CVI. Of the total number of patients in the study, 107 patients survived surgical myocardial revascularization and had a satisfactory recovery while 9 (7.8%) survived, all from the group with LVDD. Conclusion: Patients with preoperative diastolic dysfunction of the left ventricle, especially with III degree of dysfunction, are exposed to a higher postoperative risk of adverse events such as: atrial fibrillation, prolonged stay in the intensive care unit, the need for longer-term support with inotropes, and the fatal outcome was recorded exclusively in patients with LV diastolic dysfunction.

Risk factors of atrial fibrillation occurring after radical surgery of esophageal carcinoma

BackgroundAtrial fibrillation (AF) is a common complication after radical surgery of esophageal cancer. The aim of this study was to explore AF risk factors after radical surgery of esophageal carcinoma.MethodThe data of 335 patients with esophageal cancer who were admitted in our hospital from January 2014 to August 2016 for the first time were retrospectively analyzed. We retrieved the papers in some data banks using the search terms including English and Chinese search terms, and obtained 13 factors which were mentioned in more than 6 papers. The 13 factors including age, gender, history of smoking, history of hypertension, history of peripheral vascular disease, history of cardiac stents or angina pectoris, preoperative pulmonary infection, preoperative brain natriuretic peptide (BNP) level, preoperative left ventricular diastolic dysfunction, operative method, lesion location, intraoperative blood transfusion, adhesion between lymph nodes and pericardium, underwent univariate and multivariate analyses.ResultsOf the 335 patients with esophageal cancer, 48 had AF within one week after operation. Univariate analysis indicated that the age (OR: 4.89; CI: 2.53–9.47, P: 0.000), gender (OR: 2.26; CI: 1.17–4.37, P: 0.013), history of peripheral vascular disease (OR: 2.29; CI: 1.06–4.92, P: 0.030), history of cardiac stents or angina pectoris (OR: 27.30; CI: 12.44–59.91, P: 0.000), preoperative BNP level (OR: 27.13; CI: 10.97–67.06, P: 0.000), preoperative left ventricular diastolic dysfunction (OR: 2.22; CI: 1.19–4.14, P: 0.012), operative method (OR: 2.09; CI: 1.002–4.380, P: 0.046), intraoperative blood transfusion (OR: 20.24; CI: 8.39–48.82, P: 0.000), and adhesion between lymph nodes and pericardium were risk factors (OR: 2.05; CI: 1.08–3.87, P: 0.024). Furthermore, multivariate analysis displayed that advanced age (OR: 5.044; CI: 1.748–14.554, P: 0.003), male (OR: 6.161; CI: 2.143–17.715, P: 0.001), history of cardiac stents or angina pectoris (OR: 48.813; CI: 13.674–174.246, P: 0.000), preoperative BNP > 100 (OR: 41.515; CI: 9.380–183.732, P: 0.000), open surgery (OR: 3.357; CI: 1.026–10.983, P: 0.045), intraoperative blood transfusion (OR: 58.404; CI: 10.777–316.509, P: 0.000), and adhesion between lymph nodes and pericardium (OR: 3.954; CI: 1.364–11.459, P: 0.011) were risk factors which could increase the incidence of postoperative AF.ConclusionWe should pay attention to the above risk factors in order to reduce the incidence of postoperative AF.

Preoperative Left Ventricular Diastolic Dysfunction Is Associated with Pulmonary Edema after Carotid Endarterectomy.

This retrospective study was aimed to investigate the association between preoperative left ventricular (LV) cardiac function and the incidence of postoperative pulmonary edema (PE) in patients undergoing carotid endarterectomy (CEA). Most patients undergoing CEA for carotid artery stenosis have concomitant heart diseases, leading to hemodynamic instability that can cause postoperative cardiac complications such as cardiac heart failure. LV diastolic function has recently been recognized as an independent predictor of adverse cardiac events in patients undergoing cardiovascular surgery. We analyzed clinical data from the anesthetic and medical records of 149 consecutive patients who underwent CEA at our university hospital between March 2012 and March 2018. LV systolic and diastolic function were evaluated by ejection fraction and the ratio of LV early diastolic filling velocity to the peak velocity of mitral medial annulus (E/e′). Postoperative PE was diagnosed based on chest X-ray and arterial gas analysis by two independent physicians. Postoperative PE was developed in four patients (2.8%). Patients with postoperative PE were not related to preoperative low ventricular ejection fraction, but had a significantly higher E/e′ ratio than those without PE (P = 0.01). Furthermore, there was an increasing trend of PE according to the E/e′ category. Preoperative LV diastolic function evaluated by E/e′ was associated with the development of postoperative PE in patients who underwent CEA. The results suggest that the evaluation of LV diastolic dysfunction could be possibly useful to predict PE in patients undergoing CEA.

The prognostic significance of preoperative left ventricular diastolic dysfunction and left atrial enlargement on acute coronary syndrome in kidney transplantation.

Echocardiography is commonly performed as a screening test to evaluate perioperative risks before kidney transplantation. However, only limited data are available on echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) and left atrial enlargement (LAE) on acute coronary syndrome and mortality in kidney transplant recipients. We reviewed 2779 adult recipients who underwent pretransplant echocardiography from 1997 to 2012. We divided the patients into two and four groups by two categories: LVDD grades 0–1 vs. 2–3, and left atrial size quartile groups. During a mean follow-up of 4.5 years, acute coronary syndrome occurred in 89 (3.2%) patients. The recipients with LVDD grades 2–3 (P = 0.005 for non-fatal, P = 0.02 for fatal/non-fatal) and LAE (P = 0.001 for non-fatal, P = 0.03 for fatal/non-fatal) had a higher incidence of acute coronary syndrome after kidney transplantation. All-cause mortality did not differ significantly between the groups. In a multivariate analysis, LVDD of grades 2–3 (hazard ratio 2.98, 95% confidence interval 1.535–5.787; P = 0.001), and LAE (hazard ratio 1.052, 95% confidence interval 1.006–1.101; P = 0.03) were independently associated with non-fatal acute coronary syndrome. In patients who are kidney transplant candidates, pretransplant LVDD and LAE were independently associated with a higher incidence of acute coronary syndrome after kidney transplantation.

Effect of preoperative left ventricular diastolic dysfunction on mid-term outcomes after surgical ventricular restoration for ischemic cardiomyopathy

The impact of surgical ventricular restoration (SVR) on survival and major adverse cardiac events (MACEs) is still controversial. The purposes of this study were to analyze our surgical experience with SVR for ischemic cardiomyopathy and to determine the effect of preoperative left ventricular diastolic dysfunction on mid-term outcomes after SVR. Between April 2010 and May 2016, 19 patients underwent SVR. The mean age was 60 ± 11years and the mean New York Heart Association functional class was 2.9 ± 0.8. Preoperative mean left ventricular end systolic volume index (LVESVI) and ejection fraction (LVEF) were 134 ± 56mL/m2 and 24 ± 7%, respectively. The early-to-late mitral valve flow ratio (E/A) on echocardiogram was 2.4 ± 1.8 and 9 patients had E/A ≥2, excluding 2 patients with atrial fibrillation. The mean follow-up period was 29 ± 16months. One patient died of heart failure at 6months postoperative; the overall survival rate at 3years was 95%. MACEs requiring hospitalization occurred in 10 patients; E/A ≥2, or restrictive filling pattern, was the only significant predictor of MACE in multivariate analysis. Reverse remodeling was associated with E/A <2, but not E/A ≥2. There was also a significant difference between patients with E/A <2 vs. ≥2 with respect to MACE-free survival rates at 3years (100 vs. 10%; p = 0.001). The degree of preoperative diastolic dysfunction can influence the outcome after SVR. Patients with E/A ≥2 may not be good candidates for SVR.

Preoperative assessment of left ventricular diastolic function and right ventricular systolic function have independent and incremental prognostic value in prediction of early postoperative mortality in redo valve surgery.

Redo valve surgery is associated with increased risk of mortality that may be underestimated by current risk scores. In this study, we hypothesized that additional echocardiographic assessment of left ventricular diastolic and right ventricular systolic function would have independent prognostic value in the prediction of early postoperative mortality in patients undergoing redo valve surgery. We prospectively evaluated 145 patients who underwent redo mitral or aortic valve surgery at our center. All patients underwent comprehensive preoperative echocardiography. The primary outcome was all-cause mortality at 30days. The 30-day mortality rate was 11.7%. Independent of EuroSCORE II both preoperative left ventricular diastolic dysfunction and right ventricular systolic dysfunction were a significant multivariable predictors of 30-day mortality (HR 5.47; 95% CI 1.12-26.74, P=0.036 and HR 4.09; 95% CI 1.11-15.07, P=0.035, respectively) in addition to EuroSCORE II. Diastolic dysfunction remained significant when added to other clinically significant variables. The assessment of both parameters increased the discriminatory power of EuroSCORE II for prediction of early mortality and the combination identified a group at very high risk of mortality. Comprehensive preoperative echocardiography including assessment of left ventricular diastolic and right ventricular systolic function has independent prognostic value over and above EuroSCORE II in the prediction of early postoperative mortality in patients undergoing redo valve surgery. The results of preoperative echocardiography should be taken into account during the selection and perioperative management of patients undergoing redo valvular surgery.

Diastolic dysfunction of the left ventricle is associated with pulmonary edema after renal transplantation

Post-operative pulmonary complications are associated with high mortality and graft loss in renal transplantation recipients. Left ventricular diastolic dysfunction is not uncommon in patients with chronic renal failure, including those with preserved left ventricular systolic function. The purpose of this study was to determine the relationship between left ventricular diastolic dysfunction and incidence of post-operative pulmonary edema in renal transplantation recipients with preserved left ventricular systolic function. Pre-operative left ventricular function and incidence of pulmonary edema were retrospectively studied in 209 patients who underwent living-donor renal transplantation between January 2010 and October 2012. Left ventricular systolic and diastolic functions were evaluated by ejection fraction and E/E' ratio, retrospectively, using transthoracic echocardiography. Pulmonary edema was defined by evidence of pulmonary congestion on the chest X-ray together with PaO2 /FiO2 ratio < 300 mmHg. Eleven out of 190 (5.8%) renal transplantation patients with preserved left ventricular systolic function developed post-operative pulmonary edema. Patients with pulmonary edema had a significantly higher geometric mean (95% confidence interval) of E/E' ratio than those without pulmonary edema [17.8 (14.1-22.5) vs. 11.1 (10.6-11.7), P = 0.001]. Pre-operative left ventricular diastolic dysfunction correlated with the development of post-operative pulmonary edema in renal transplantation recipients. Meticulous intraoperative volume therapy is important to avoid post-operative pulmonary edema in such patients.

P-11 Prognostic implications of the preoperative left ventricular diastolic dysfunction as assessed by E/e′ in patients undergoing off-pump coronary artery surgery

P-11 Prognostic implications of the preoperative left ventricular diastolic dysfunction as assessed by E/e′ in patients undergoing off-pump coronary artery surgery

Biventricular diastolic filling patterns after coronary artery bypass graft surgery

We sought to study the evolution of biventricular filling properties after coronary artery bypass grafting. The evolution of diastolic function as defined with newer echocardiographic modalities after coronary artery bypass grafting surgery is unknown in patients with preoperative left ventricular diastolic dysfunction. Transthoracic echocardiography was performed preoperatively and 48 hours and 6 months after coronary artery bypass grafting in 49 patients (randomized to milrinone [n = 25]) or placebo [n = 24]) with preoperative left ventricular diastolic dysfunction classified according to published criteria. Mild right ventricular diastolic dysfunction was defined as the ratio of early to atrial filling velocity of less than 1 in transtricuspid flow or the velocity of reversed atrial flow of greater than 50% of that of systolic flow in hepatic venous flow or the ratio of tricuspid annulus velocity during early and atrial filling of less than 1 if both the ratio of early to atrial filling velocity and the ratio of systolic to diastolic velocity was greater than 1 in hepatic venous flow. Moderate right ventricular diastolic dysfunction was diagnosed when there was a ratio of early to atrial filling velocity of greater than 1 with a ratio of systolic to diastolic velocity of less than 1. Severe right ventricular diastolic dysfunction was defined as a ratio of early to atrial filling velocity of greater than 1 associated with reversed systolic wave in hepatic venous flow. Moderate and severe left ventricular diastolic dysfunction increased from preoperatively to 48 hours after coronary artery bypass grafting from 8.2% to 53.7% and from 2.0% to 9.7%, respectively (P < .0001, 48 hours vs preoperatively for both), and the patterns at 6 months were similar to those observed preoperatively. Similar evolution over time was found for right ventricular diastolic dysfunction. In patients with preoperative left ventricular diastolic dysfunction, biventricular filling patterns are impaired initially but return to preoperative status 6 months after coronary artery bypass grafting.

Recovery of Left Ventricular Diastolic Function after Coronary Bypass Surgery

Effects of myocardial revascularization in patients with preoperative left ventricular diastolic dysfunction have not been well characterized. The aim of this study was to evaluate the recovery of diastolic function following successful coronary artery bypass surgery. Forty-five patients with normal diastolic function were selected for comparison with 45 patients who had a pattern of diastolic dysfunction. Mitral flow peak velocity ratios and atrial filling fractions were measured by pulsed Doppler echocardiography 24 hours before surgery. Diastolic dysfunction was defined as a mitral flow peak velocity ratio of less than one. After coronary artery bypass graft surgery, patients who required hemodynamic support were excluded from further study. Group 1 consisted of 38 patients (mean age, 59 ± 9 years) with normal preoperative peak velocity ratios. Group 2 consisted of 33 patients (mean age, 52 ± 9) with preoperative diastolic dysfunction. In group 1, mitral flow peak velocity ratios decreased immediately after cardiopulmonary bypass and persisted for 24 hours, returning to normal at 72 hours. In group 2, peak velocity ratios decreased immediately after cardiopulmonary bypass and persisted for 10 days. Similar changes occurred in atrial filling fractions in the 2 groups. These findings indicate that recovery of left ventricular diastolic function is prolonged in patients with preoperative dysfunction, which may reflect the time required for reversal of the effects of chronic myocardial ischemia.