Key result
Stage II–III LV diastolic dysfunction is linked to ~5.2-fold higher postoperative pneumonia after elective CABG.
Why the study?
Left ventricular diastolic dysfunction can contribute to postcapillary pulmonary hypertension, and associated hypoxemia may worsen post-cardiac surgery outcomes. The study investigated the impact of LV DD on postoperative respiratory adverse events in patients undergoing CABG.
Does moderate-to-severe left ventricular diastolic dysfunction (Stage II/III) increase the risk of postoperative respiratory adverse events, such as pneumonia and hypoxemia, in patients undergoing elective CABG?
Observational (n=56)
No
Does moderate-to-severe left ventricular diastolic dysfunction (Stage II/III) increase the risk of postoperative respiratory adverse events, such as pneumonia and hypoxemia, in patients undergoing elective CABG?
Odds Ratio: 5.25 (95% CI 1.22–21.4)
Absolute Event Rate: 38.89% vs 10.81%
p-value: p=0.027
Preoperative screening for left ventricular diastolic dysfunction in CABG patients can identify those at a substantially elevated risk for postoperative pneumonia and hypoxemia, allowing for targeted preventive respiratory care.
BACKGROUND: Left ventricular diastolic dysfunction (LV DD) is the most dominant cause of heart failure with preserved ejection fraction (HFpEF) worldwide. This pathological condition may contribute to postcapillary pulmonary hypertension (pcPH) development. Hypoxemia, often observed in pcPH, may significantly negatively impact the course of hospitalization in patients after cardiac surgery. The aim of our study was to investigate the impact of LV DD on the frequency of postoperative respiratory adverse events (RAE) in patients undergoing Coronary Artery Bypass Grafting (CABG). METHODS: The left ventricular (LV) diastolic function was assessed in 56 consecutive patients admitted for CABG. We investigated the relationship between LV DD and postoperative respiratory adverse events (RAE) in groups with normal LV diastolic function and LV DD stage I, II, and III. RESULTS: Left ventricular diastolic dysfunction stage I was observed in 11 patients (19.6%) and LV DD stage II or III in 19 patients (33.9%). Arterial blood partial pressure of oxygen (PaO2) to the fraction of inspired oxygen (FiO2) index during postoperative mechanical ventilation was significantly lower in LV DD stage II or III than in the group with normal LV diastolic function. Patients with DD stage II or III had a higher occurrence of postoperative pneumonia than the group with normal LV diastolic function. CONCLUSIONS: Left ventricular diastolic dysfunction is widespread in cardiac surgery patients and is an independent risk factor for lower minimal PaO2/FiO2 index during mechanical ventilation and higher occurrence of pneumonia.
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Braksator et al. (2023) conducted an observational in Chronic coronary artery disease requiring elective CABG (n=56). Left ventricular diastolic dysfunction (Stage II or III) vs. Normal left ventricular diastolic function or Stage I diastolic dysfunction was evaluated on Postoperative pneumonia (OR 5.25, 95% CI 1.22-21.4, p=0.027). Left ventricular diastolic dysfunction stage II or III was associated with a significantly higher occurrence of postoperative pneumonia compared to normal or stage I function (OR 5.25, 95% CI 1.22-21.4, p=0.027) in patients undergoing elective CABG.
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