Pre-operative point-of-care assessment of left ventricular diastolic dysfunction, an observational study

Abstract

Abstract 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. Trial registration Clinicaltrials.gov, Identifier: NCT 03349593 . Date of registration 21/11/2017. https://clinicaltrials.gov .

Keywords

• Diastole
• Left ventricular dysfunction
• Point-of-care ultrasound
• Prospective studies
• Risk assessment
• Tissue Doppler