title: Perioperative assessment of diastolic dysfunction.
abstract: Assessment of diastolic function should be a component of a comprehensive perioperative transesophageal echocardiographic examination. Abnormal diastolic function exists in >50% of patients presenting for cardiac and high-risk noncardiac surgery, and has been shown to be an independent predictor of adverse postoperative outcome. Normalcy of systolic function in 50% of patients with congestive heart failure implicates diastolic dysfunction as the probable etiology. Comprehensive evaluation of diastolic function requires the use of various, load-dependent Doppler techniques This is further complicated by the additional effects of dehydration and anesthetic drugs on myocardial relaxation and compliance as assessed by these Doppler measures. The availability of more sophisticated Doppler techniques, e.g., Doppler tissue imaging and flow propagation velocity, makes it possible to interrogate left ventricular diastolic function with greater precision, analyze specific stages of diastole, and to differentiate abnormalities of relaxation from compliance. Additionally, various Doppler-derived ratios can be used to estimate left ventricular filling pressures. The varying hemodynamic environment of the operating room mandates modification of the diagnostic algorithms used for ambulatory cardiac patients when left ventricular diastolic function is evaluated with transesophageal echocardiography in anesthetized surgical patients.
authors.affiliation: Department of Anesthesia and Critical Care Medicine, Beth Israel Deaconess Medical Center, CC-454, 1 Deaconess Rd., Boston, MA 02215, USA. rmatyal@bidmc.harvard.edu
authors.forename: Robina
authors.initials: R
authors.lastname: Matyal
authors.forename: Nikolaos J
authors.initials: NJ
authors.lastname: Skubas
authors.forename: Stanton K
authors.initials: SK
authors.lastname: Shernan
authors.forename: Feroze
authors.initials: F
authors.lastname: Mahmood
mesh_terms: D000777:Anesthetics / Q000009:adverse effects; D003971:Diastole; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D019990:Perioperative Care; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects; D017725:Ventricular Pressure
chemical_list: D000777:Anesthetics