Left ventricular diastolic dysfunction of the cardiac surgery patient; a point of view for the cardiac surgeon and cardio-anesthesiologist

Efstratios E Apostolakis; Nikolaos G Baikoussis; Haralabos Parissis; Stavros N Siminelakis; Georgios S Papadopoulos

doi:10.1186/1749-8090-4-67

Table 2 High risk groups for developing DD

From: Left ventricular diastolic dysfunction of the cardiac surgery patient; a point of view for the cardiac surgeon and cardio-anesthesiologist

Systolic dysfunction	Only 50% to 60% of patients with clinical findings of congestive heart failure have an abnormal systolic function, which is indicated by reduced ejection fraction. The remaining 40%-50% of pts, have congestive heart failure with normal systolic function and represent the patients with diastolic dysfunction [22, 23]. For clarification, Sanderson proposed the term "heart failure with normal ejection fraction" (HFNEF) for left ventricular diastolic dysfunction, and heart failure with reduced ejection fraction (HFREF) for systolic dysfunction of left ventricle [78]. According to this classification, the main difference between HFNEF and HFREF is the degree of ventricular remodeling accompanied by increased ventricular volume in HFREF [78]. In other words, distinction between systolic and diastolic dysfunction is very important because the latter has a lower mortality (5%-8% annually), and requires different medical management (no inotropes) [22, 23].
LVH	In patients with AS, preoperative DD is attributable to hypertension, myocardial hypertrophy- fibrosis, and/or to ischemia [64].
CAD	Patients with CAD are prone for the development of postoperative myocardial diastolic dysfunction [39]. Left ventricular filling abnormalities have been detected in as many as 90% of patients [39]. Possible related factors that were considered were ischemia, hypertrophy, and hypertension [79].
DM	All insulin--dependent diabetes mellitus patients with left diastolic dysfunction had evidence of definite autonomic neuropathy [80]. Moreover, diabetic patients with autonomic neuropathy form a subgroup of particularly high mortality and cardiovascular event risk [81, 82].
Age	Aging is correlated to DD through an increase upon wall thickness (secondary to enlargement of cardiac myocytes), and changes in the vasculature, the diameter, and vascular stiffness of the aorta and large arteries [83]. Up to 60% of geriatric patients with normal EF, following non-cardiac surgery, had been postoperatively diagnosed with diastolic dysfunction [35].

High risk groups for DD

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