Dose Impaired Relaxation of Left Ventricle Affect Early Outcomes
Although systolic dysfunction is revealed as a prognostic factor in cardiac surgery , the role of diastolic dysfunction as a predictive factor is less evaluated. In this retrospective study from 872 patients that underwent isolated coronary artery bypass graft(Jan 2008-Feb 2009),388 patients had normal left ventricular ejection fraction (>50%). These are divided in two groups, Group 1: 361 patients without diastolic dysfunction (impaired relaxation) and Group 2: 27 patients with diastolic dysfunction ( impaired relaxation) . Mean age in group 1 was 57.72 year and in group 2 was 61.16 year (P =0.07). Risk factors such as diabetes mellitus, hypertention and dyslipidemia were similar. Although overall complication rate was higher in group 2( 11.1% vs 2.8% P value 0.05),but when each complication was studied individually no significant statistical difference was found. Also no significant statistical difference was found in mortality (2.2% in group 1 vs 7.4% in group 2 P =0.1). In conclusion, from clinical standpoint diastolic dysfunction can be an important factor in assessing surgical outcome in patients whom underwent coronary artery bypass grafting.
Rihal CS, Nishimura RA, Hatle LK, et al. Systolic and diastolic dysfunction in patients with clinical diagnosis of dilated cardiomyopathy: relation to symptoms and prognosis. Circulation 1994; 90: 2772-9.
Lewis KP. Early intervention of inotropic support in facilitating weaning from cardiopulmonary bypass: the New England Deaconess Hospital experience. J Cardiothorac Vasc Anesth 1993; 7: 40-5.
Rao V, Ivanov J, Weisel RD, et al. Predictors of low cardiac output syndrome after coronary artery bypass. J Thorac Cardiovasc Surg 1996; 112: 38-51.
Bernard F, Denault A, Babin D, Goyer C, Couture P, Couturier A, Buithieu J. Diastolic dysfunction is predictive of difficult weaning from cardiopulmonary bypass. Anesth Analg 2001; 92: 291-8.
Salem R, Denault AY, Couture P, Be'lisle S, Fortier A, Guertin MC, Carrier M, Martineau R. Left ventricular enddiastolic pressure is a predictor of mortality in cardiac surgery independently of left ventricular ejection fraction. Br J Anaesth 2006; 97: 292-7.
Alsaddique AA. Recognition of diastolic heart failure in the post operative heart. Eur J Cardio-thorac surg 2008; 34: 1141-1148.
Garcia-Fernandez MA, Azevedo J, Moreno M, Bermejo J, Perez-Castellano N, Puerta P, Desco M, Antoranz C, Serrano JA, Garcia E, Delcan JL, Regional diastolic function in ischaemic heart disease using pulse wave Doppler tissue imaging. Eur Heart J 1999; 20 (7): 496-505.
Merello L, Riesle E, Alburquerque J, Torres H, Ara'nguiz- Santander E, Pedemonte O, Westerberg B. Risk Scores Do not predict high mortality after coronary artery bypass surgery in the presence of diastolic dysfunction. Ann Thorac Surg 2008; 85: 1247-55.
Vaskelyte J, Stoskute N, Kinduris S, Ereminiene E. Coronary artery bypass grafting in patients with severe left ventricular dysfunction: predictive significance of left ventricular diastolic filling pattern. Eur J Echo 2001; 2: 62-67.
Hillis G, Moller J, Pellikka P, et al. Noninvasive estimation of left ventricular filling pressure by E/e' is a powerful predictor of survival after acute myocardial infarction. J Am Coll Cardiol 2004; 43: 360-7.
Xie GY, Berk MR, Smith MD, Gurley JC, DeMaria AN. Prognostic value of Doppler transmitral flow patterns in patients with congestive heart failure. J Am Coll Cardiol 1994; 24: 132-9.
Sheen WF, Tribouilloy C, Rey JL, et al. Prognostic significance of Doppler-derived left ventricular diastolic filling variables in dilated cardiomyopathy. Am Heart J 1992; 124: 1524-33.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.