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Presence of Preoperative Diastolic Dysfunction Predicts Postoperative Pulmonary Edema and Cardiovascular Complications in Patients Undergoing Noncardiac Surgery
Author(s) -
Cho DongHyuk,
Park SeongMi,
Kim MiNa,
Kim SuA,
Lim HaeJa,
Shim WanJoo
Publication year - 2014
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12285
Subject(s) - medicine , mace , cardiology , pulmonary edema , perioperative , diastole , heart failure , pulmonary artery , edema , left ventricular hypertrophy , surgery , blood pressure , percutaneous coronary intervention , lung , myocardial infarction
Objective The aim of this study was to evaluate the impact of left ventricular diastolic dysfunction on predicting postoperative pulmonary edema and major cardiovascular events ( MACE ) in patients who underwent low‐ or intermediate‐risk noncardiac surgery. Methods A total of 692 patients aged >60 years who underwent transthoracic echocardiography ( TTE ) before undergoing elective low‐ or intermediate‐risk noncardiac surgery were prospectively enrolled. The medical history and TTE variables were assessed. Each patient was clinically evaluated for postoperative pulmonary edema and MACE . The presence of postoperative pulmonary edema and MACE were evaluated during a 30‐day follow‐up period after surgery. Results We identified 166 patients with pulmonary edema and 49 patients with MACE . After adjusting for clinical and TTE variables, multivariate analysis demonstrated that a ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus ( E / e ′) >15, pulmonary artery systolic pressure ( PASP ) ≥35 mmHg, and left ventricular hypertrophy ( LVH ) were significantly associated with postoperative pulmonary edema ( E / e ′, P < 0.001: PASP , P = 0.005; LVH , P = 0.017). The multivariate analysis for MACE after adjusting for clinical risk factors indicated that MACE were significantly associated with an E / e ′ > 15 (P < 0.001). Conclusion E / e ′ > 15, PASP elevation, and LVH on preoperative TTE predicted postoperative pulmonary edema, and E / e ′ > 15 predicted MACE in the patients who underwent low‐ or intermediate‐risk noncardiac surgery. Thus, we believe that clinicians need to be cautious when providing perioperative care to patients with high E / e ′ ratios who are indicated for TTE .