title: Diastolic dysfunction in patients undergoing cardiac surgery: the role of gender and age-gender interaction.
abstract: OBJECTIVE
  To test the hypothesis that females presenting for coronary artery bypass graft (CABG) surgery are at a higher risk of left ventricular diastolic dysfunction (LVDD) and that age and gender interact to influence this risk.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Tertiary university hospital.
  
  
  METHODS
  Eight hundred-ninety-five adult patients undergoing CABG surgery.
  
  
  METHODS
  None.
  
  
  RESULTS
  Baseline diastolic function was graded according to a predefined Doppler-based algorithm, which defined LVDD as a binary variable (grades 2 and 3 only) and as a continuous variable (E/e' ratio). The authors found that women were more likely to present with LVDD in 2 multivariate regression models using both LVDD definitions (odds ratio = 2.7; p<0.0001 for logistic model, and parameter estimate (PE) = 2.8; p<0.0001 for the linear model). In addition, there was a significant age and gender interaction on the risk of LVDD in the linear model (PE = 0.08; p = 0.01). A restricted cubic splines analysis revealed a progressively higher risk of LVDD (predicted E/e' ratio) among older women.
  
  
  CONCLUSIONS
  The authors confirmed that women undergoing CABG surgery are at higher risk of LVDD compared to men with a significant age-gender interaction suggesting a possible age-related differential effect on LVDD between the genders, a phenomenon previously demonstrated in preclinical studies. Therapies aimed at amelioration of diastolic dysfunction additionally should consider the higher risk in females, especially within the older subset of the patient population.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC.
authors.forename: Renata G
authors.initials: RG
authors.lastname: Ferreira
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC.
authors.forename: Alina
authors.initials: A
authors.lastname: Nicoara
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC.
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Phillips-Bute
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Mani
authors.initials: M
authors.lastname: Daneshmand
authors.affiliation: Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Boston, MA.
authors.forename: Jochen D
authors.initials: JD
authors.lastname: Muehlschlegel
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC; Department of Surgery, Duke University Medical Center, Durham, NC. Electronic address: madhav.swaminathan@duke.edu.
authors.forename: Madhav
authors.initials: M
authors.lastname: Swaminathan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D005260:Female; D054144:Heart Failure, Diastolic / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012727:Sex Characteristics; D059289:Vascular Stiffness / Q000502:physiology
keywords: aging; coronary artery disease; diastole; diastolic dysfunction; surgery; women