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Pre-operative point-of-care assessment of left ventricular diastolic dysfunction, an observational study
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.ORCID iD: 0000-0002-3292-7471
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
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2022 (English)In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 22, no 1, article id 96Article in journal (Refereed) Published
Abstract [en]

Background: Left ventricular (LV) diastolic dysfunction is an acknowledged peri-operative risk factor that should be identified before surgery. This study aimed to evaluate a simplified echocardiographic method using e’ and E/e’ for identification and grading of diastolic dysfunction pre-operatively.

Methods: Ninety six ambulatory surgical patients were consecutively included to this prospective observational study. Pre-operative transthoracic echocardiography was conducted prior to surgery, and diagnosis of LV diastolic dysfunction was established by comprehensive and simplified assessment, and the results were compared. The accuracy of e’-velocities in order to discriminate patients with diastolic dysfunction was established by calculating accuracy, efficiency, positive (PPV) and negative predictive (NPV) values, and area under the receiver operating characteristic curve (AUROC).

Results: Comprehensive assessment established diastolic dysfunction in 77% (74/96) of patients. Of these, 22/74 was categorized as mild dysfunction, 43/74 as moderate dysfunction and 9/74 as severe dysfunction. Using the simplified method with e’ and E/e’, diastolic dysfunction was established in 70.8% (68/96) of patients. Of these, 8/68 was categorized as mild dysfunction, 36/68 as moderate dysfunction and 24/68 as severe dysfunction. To discriminate diastolic dysfunction of any grade, e’-velocities (mean < 9 cm s− 1) had an AUROC of 0.901 (95%CI 0.840–0.962), with a PPV of 55.2%, a NPV of 90.9% and a test efficiency of 0.78.

Conclusions: The results of this study indicate that a simplified approach with tissue Doppler e’-velocities may be used to rule out patients with diastolic dysfunction pre-operatively, but together with E/e’ ratio the severity of diastolic dysfunction may be overestimated.

Place, publisher, year, edition, pages
BioMed Central, 2022. Vol. 22, no 1, article id 96
Keywords [en]
Diastole, Left ventricular dysfunction, Point-of-care ultrasound, Prospective studies, Risk assessment, Tissue Doppler, Transthoracic echocardiography
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:umu:diva-194280DOI: 10.1186/s12871-022-01642-4ISI: 000778706100003PubMedID: 35382761Scopus ID: 2-s2.0-85127625909OAI: oai:DiVA.org:umu-194280DiVA, id: diva2:1654920
Funder
Norrbotten County Council, NLL-733291Available from: 2022-04-29 Created: 2022-04-29 Last updated: 2022-04-29Bibliographically approved

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Stenberg, YlvaLindberg, AnneAroch, RomanHultin, MagnusWallden, JakobMyrberg, Tomi

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