title: Effect of diastolic dysfunction on postoperative outcomes after cardiovascular surgery: A systematic review and meta-analysis.
abstract: The objective of this study was to investigate the effect of preoperative diastolic dysfunction on postoperative mortality and morbidity after cardiovascular surgery.
  
  
  
  We systematically searched for articles that assessed the prognostic role of diastolic dysfunction on cardiovascular surgery in PubMed, Cochrane Library, Web of Science, Embase, and Scopus until February 2016. Twelve studies (n = 8224) met our inclusion criteria. Because of the scarcity of outcome events, fixed-effects meta-analysis was performed via the Mantel-Haenszel method.
  
  
  
  Preoperative diagnosis of diastolic dysfunction was associated with greater postoperative mortality (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.54-3.71; P < .0001), major adverse cardiac events (OR, 2.07; 95% CI, 1.55-2.78; P ≤ .0001), and prolonged mechanical ventilation (OR, 2.08; 95% CI, 1.04-4.16; P = .04) compared with patients without diastolic dysfunction among patients who underwent cardiovascular surgery. The odds of postoperative myocardial infarction (OR, 1.29; 95% CI, 0.82-2.05; P = .28) and atrial fibrillation (OR, 2.67; 95% CI, 0.49-14.43; P = .25) did not significantly differ between the 2 groups. Severity of preoperative diastolic dysfunction was associated with increased postoperative mortality (OR, 21.22; 95% CI, 3.74-120.33; P = .0006) for Grade 3 diastolic dysfunction compared with patients with normal diastolic function. Inclusion of left ventricular ejection fraction (LVEF) <40% accompanying diastolic dysfunction did not further impact postoperative mortality (P = .27; I(2) = 18%) compared with patients with normal LVEF and diastolic dysfunction.
  
  
  
  Presence of preoperative diastolic dysfunction was associated with greater postoperative mortality and major adverse cardiac events, regardless of LVEF. Mortality was significantly greater in grade III diastolic dysfunction.
authors.affiliation: Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Roop
authors.initials: R
authors.lastname: Kaw
authors.affiliation: Health Outcomes and Clinical Epidemiology Section, Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru. Electronic address: adrianhernandezdiaz@gmail.com.
authors.forename: Adrian V
authors.initials: AV
authors.lastname: Hernandez
authors.affiliation: Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Vinay
authors.initials: V
authors.lastname: Pasupuleti
authors.affiliation: Medicine Institute Center for Value Based Care Research, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshpande
authors.affiliation: Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Va.
authors.forename: Vijaiganesh
authors.initials: V
authors.lastname: Nagarajan
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain; University of Connecticut School of Pharmacy, Storrs, Conn.
authors.forename: Hector
authors.initials: H
authors.lastname: Bueno
authors.affiliation: Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
authors.affiliation: Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, Calif.
authors.forename: John P A
authors.initials: JP
authors.lastname: Ioannidis
authors.affiliation: Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Mass.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
mesh_terms: D006348:Cardiac Surgical Procedures; D003327:Coronary Disease / Q000503:physiopathology* / Q000601:surgery*; D003971:Diastole / Q000502:physiology*; D006801:Humans; D012307:Risk Factors; D016896:Treatment Outcome
keywords: cardiovascular surgical procedures; diastolic dysfunction; meta-analysis; mortality