title: Perioperative Diastolic Dysfunction in Patients Undergoing Noncardiac Surgery Is an Independent Risk Factor for Cardiovascular Events: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  The prognostic value of perioperative diastolic dysfunction (PDD) in patients undergoing noncardiac surgery remains uncertain, and the current guidelines do not recognize PDD as a perioperative risk factor. This systematic review aimed to investigate whether existing evidence supports PDD as an independent predictor of adverse events after noncardiac surgery.
  
  
  METHODS
  Ovid MEDLINE, PubMed, EMBASE, the Cochrane Library, and Google search engine were searched for English-language citations in April 2015 investigating PDD as a risk factor for perioperative adverse events in adult patients undergoing noncardiac surgery. Two reviewers independently assessed the study risk of bias. Extracted data were verified. Random-effects model was used for meta-analysis, and reviewers' certainty was graded.
  
  
  RESULTS
  Seventeen studies met eligibility criteria; however, 13 contributed to evidence synthesis. The entire body of evidence addressing the research question was based on a total of 3,876 patients. PDD was significantly associated with pulmonary edema/congestive heart failure (odds ratio [OR], 3.90; 95% CI, 2.23 to 6.83; 3 studies; 996 patients), myocardial infarction (OR, 1.74; 95% CI, 1.14 to 2.67; 3 studies; 717 patients), and the composite outcome of major adverse cardiovascular events (OR, 2.03; 95% CI, 1.24 to 3.32; 4 studies; 1,814 patients). Evidence addressing other outcomes had low statistical power, but higher long-term cardiovascular mortality was observed in patients undergoing open vascular repair (OR, 3.00; 95% CI, 1.50 to 6.00). Reviewers' overall certainty of the evidence was moderate.
  
  
  CONCLUSIONS
  Evidence of moderate certainty indicates that PDD is an independent risk factor for adverse cardiovascular outcomes after noncardiac surgery.
authors.affiliation: From the Department of Anesthesiology, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada (A.F., H.Y.); School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada (M.T.A.); Department of Cardiology and Nuclear Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (T.R.); and Department of Epidemiology and Community Medicine, Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (G.A.W.).
authors.forename: Ashraf
authors.initials: A
authors.lastname: Fayad
authors.forename: Mohammed T
authors.initials: MT
authors.lastname: Ansari
authors.forename: Homer
authors.initials: H
authors.lastname: Yang
authors.forename: Terrence
authors.initials: T
authors.lastname: Ruddy
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology*; D054144:Heart Failure, Diastolic / Q000453:epidemiology*; D006801:Humans; D019990:Perioperative Care; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*