The association between preoperative diastolic dysfunction and postoperative complications in patients undergoing non-cardiac surgery

Introduction: The global increase in non-cardiac surgeries has emphasized the need for improved preoperative risk stratification, particularly as cardiovascular complications remain a leading cause of morbidity and mortality. While left ventricular systolic function is a known determinant of cardiac risk, recent studies suggest that diastolic dysfunction may also play a critical role in predicting postoperative outcomes. This study aims to evaluate the association between diastolic dysfunction and postoperative heart failure in patients undergoing non-cardiac surgery.

Material and method: This retrospective study included 3,882 consecutive adult patients who underwent non-cardiac surgery at Tel Aviv Medical Center between March 2011 and March 2023 and had preoperative echocardiograms. Diastolic dysfunction was graded based on echocardiographic guidelines, and patients were divided into two groups – grade 0 or 1 vs grade 2 or 3. The primary outcome was the occurrence of acute heart failure or mortality, and secondary outcomes included in-hospital mortality, postoperative pulmonary edema, and the need for vasoactive medications.

Results and discussion: High-grade diastolic dysfunction (grades 2 or 3) was associated with a significantly higher incidence of the primary outcome (22.3% vs 11.6%, OR 2.1; 95% CI, 1.7–2.6; P < 0.001). The high-grade group had also a significantly higher rates of in-hospital mortality (9.1% vs. 4.2%, OR 2.2; 95% CI, 1.6–3.0, P < 0.001), postoperative pulmonary edema (3.8% vs. 0.7%, OR 4.9; 95% CI, 2.9–8.4, P < 0.001), and longer hospital length of stays (15.4 vs. 12 days, P < 0.001). Use of furosemide and vasoactive medications was also more frequent in patients with high-grade diastolic dysfunction.

Conclusion: Diastolic dysfunction is an independent predictor of adverse postoperative outcomes, including heart failure and mortality, in patients undergoing non-cardiac surgery. Incorporating diastolic function into preoperative risk assessments may improve perioperative management, particularly in patients with higher grades of dysfunction.