Diastolic Dysfunction in Preoperative Normotensive Normoglycemic Patients Older than 50 years-A Hospital Based Prevalence Study

Introduction: Preoperative assessment of heart function has typically focused on evaluating left ventricular ejection fraction (LVEF) which measures the systolic function of the heart. Recent evidence suggests that diastolic dysfunction is reported in more than 50% of geriatric patients undergoing cardiac and non-cardiac surgery, which may cause substantial increase in morbidity and mortality in perioperative period.

Diastolic dysfunction (DD) is usually asymptomatic at rest, but as it progresses with age, it can become unmasked by exercise or when the cardiovascular system is stressed beyond its physiological reserve such as in those undergoing surgery.The aim of our research was to study the prevalence of diastolic dysfunction with the help classic and new doppler parameters in preoperative patients.

Methods: Two hundred and sixty patients older than 50 years attending preoperative assessment clinic were divided into three groups, group A 50-60 years, group B 60-70 years, group C 70-80 years underwent transthoracic echocardiography. Two-dimensional (2-D), pulse wave and tissue doppler imaging were performed according to a standardized protocol.

Results: In the group C, shorter deceleration time, higher velocity of mitral in flow atrial phase (A), and lower early mitral inflow velocity(E), and (E/A) ratio less than one were observed and it was statistically significant compared to group A and B. Left atrial volume index was more in Group C and there was no change in ejection fraction between groups.Mitral annular velocity (E/e1) in group C(average 13.2±1.1) was elevated compared to other two groups.

Conclusions: Isolated focus on normal LVEF may not be sufficient to describe the overall heart function in preop patients. DD has been associated with increased perioperative risk so early recognition, is mandatory and possible with modern echographic indices.