Association of Abnormal Echocardiographic Diastolic Parameters and Postoperative Major Adverse Cardiac Events and Mortality in Patients Undergoing Hip Fracture Surgery: A Retrospective Cohort Study

Abstract BackgroundPerioperative diastolic dysfunction has been proposed as an independent predictor of postoperative major adverse cardiac events (MACE) after non-cardiac surgery. However, studies supporting this association have included patients undergoing elective procedures and employed variable echocardiographic approaches to assess diastolic function. This study aimed to evaluate the relationship between abnormal diastolic parameters in patients undergoing hip fracture surgery and postoperative MACE and mortality, utilizing a multiparametric and contemporary approach to assess diastolic function.MethodsIn this retrospective cohort study, data from adult patients with preoperative echocardiograms undergoing hip fracture repair from April 2016 to June 2021 was collected. Abnormal echocardiographic diastolic parameters were defined as E/e’ ratio > 14, TRV > 2.8 m/sec and LAVI > 34 mL/m2. Patients were divided into two groups based on the number of abnormal parameters: (1) 0 or 1 abnormal and (2) 2 or 3 abnormal. MACE was defined as postoperative myocardial infarction, postoperative heart failure, postoperative pulmonary edema, or death within 30-days of procedure.ResultsOf the 148 patients included in the final analysis, postoperative MACE occurred in 15.5% (n = 23). When grouped by abnormal echocardiographic diastolic data, MACE rates were 8.6% in group 1 versus 23.9% in group 2 (P = 0.011). Similarly, 1-year and 2-year mortality was higher in group 2 compared to group 1 (31.3% vs. 13.6%; P = 0.009 and 43.3% vs. 19.8%; P = 0.002).ConclusionsA higher proportion of abnormal diastolic parameters including E/e’ ratio, TRV and LAVI is associated with an increased risk of post-operative MACE, 1-year and 2-year mortality in patients undergoing hip fracture surgery. Appraisal of these diastolic indices may help identify hip fracture patients at highest risk for MACE and open avenues for better preoperative optimization and postoperative management.