Boersma, Eric H.

Bueno, Hector

Cho, Jae Hyung

Deshpande, Abhishek

Hernandez, Adrian

Ioannidis, John

Kaw, Roop

Nagarajan, Vijaiganesh

Pasupuleti, Vinay

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Heart Failure and Cardiomyopathies
A818
JACC March 17, 2015
Volume 65, Issue 10S
ImPAct of dIAstolIc dysfunctIon on Post-oPerAtIve outcomes After cArdIAc 
surgery: A metA-AnAlysIs
Poster Contributions
Poster Hall B1
Saturday, March 14, 2015, 10:00 a.m.-10:45 a.m.
Session Title: Many Faces of Heart Failure
Abstract Category: 14.  Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1113-201
Authors: Jae Hyung Cho, Adrian Hernandez, Vinay Pasupuleti, Abhishek Deshpande, Vijaiganesh Nagarajan, Hector Bueno, John 
Ioannidis, Eric H. Boersma, Roop Kaw, Cleveland Clinic, Cleveland, OH, USA
Background: The impact of diastolic dysfunction, found on pre-operative echocardiogram, on post-operative mortality and complications 
after cardiac surgery has been investigated only in small studies and the results have been controversial.
methods: We searched for articles which investigated the prognostic role of diastolic dysfunction on cardiac surgery in PubMed, Cochrane 
Library, Web of Science, Embase and Scopus until August 2014. A total of 14 studies were included in our meta-analysis. The primary 
outcome was post-operative mortality and the secondary outcomes were major adverse cardiac events (MACE), myocardial infarction (MI), 
atrial fibrillation (AF) and prolonged mechanical ventilation. Due to scarcity of outcome events, fixed-effects meta-analysis was performed 
using the Mantel-Haenszel method.
results: Diastolic dysfunction on pre-operative echocardiogram was associated with higher post-operative mortality (OR 2.04, 95% CI 
1.29-3.25; p=0.002), MACE (OR 1.86, 95% CI 1.32-2.63; p= 0.004) and prolonged mechanical ventilation (OR 2.08, 95% CI 1.04-4.16; 
p=0.04) among patients who underwent cardiac surgery. Post-operative MI and AF did not differ between the two groups. In a subgroup 
analysis, decreased left ventricular ejection fraction (LVEF) among patients with diastolic dysfunction, did not impact post-operative 
mortality (p= 0.32; I2=0%) when compared to patients with normal LVEF and diastolic dysfunction. Severity of pre-operative diastolic 
dysfunction was associated with increased post-operative mortality (OR 21.22, 95% CI 3.74-120.33; p=0.0006) and MACE (OR 5.15, 95% 
CI 2.90-9.14; p<0.00001) for Grade 3 diastolic dysfunction compared to patients with normal diastolic function. Due to scarcity of studies, 
subgroup analysis by type of cardiac surgery (CABG vs. CABG with valvular surgery) and type of echocardiogram (transthoracic vs. 
transeophageal) could not be done.
conclusion:  Presence of diastolic dysfunction on pre-operative echocardiogram was associated with higher post-operative mortality and 
MACE regardless of LVEF. Mortality and MACE were significantly higher in Grade III diastolic dysfunction.


IMPACT OF DIASTOLIC DYSFUNCTION ON POST-OPERATIVE OUTCOMES AFTER CARDIAC SURGERY: A META-ANALYSIS 

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IMPACT OF DIASTOLIC DYSFUNCTION ON POST-OPERATIVE OUTCOMES AFTER CARDIAC SURGERY: A META-ANALYSIS

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