Key result
Left ventricular diastolic dysfunction was independently associated with an increased risk of perioperative myocardial injury in elderly patients undergoing non-cardiac surgery (OR 3.029).
Cohort (n=151)
No
In elderly patients undergoing non-cardiac surgery, left ventricular diastolic dysfunction is an independent predictor of perioperative myocardial injury, which significantly increases the risk of 30-day postoperative cardiovascular events.
May support preoperative diastolic assessment in elderly noncardiac surgery patients; leaves open whether intervention reduces perioperative myocardial injury.
BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) is useful for detecting myocardial injury and is expected to become a prognostic marker in patients undergoing non-cardiac surgery. The aim of this pilot study evaluating the efficacy of β-blocker therapy in a perioperative setting (MAMACARI study) was to assess perioperative myocardial injury (PMI) in elderly patients with preserved ejection fraction (EF) undergoing non-cardiac surgery. METHODS AND RESULTS: In this prospective observational cohort study of 151 consecutive patients with preserved EF and aged >60 years who underwent non-cardiac surgery, serum levels of hs-cTnT were measured before and on postoperative days 1 and 3 after surgery. PMI was defined as postoperative hs-cTnT >0.014 ng/mL and relative hs-cTnT change ≥20%. A total of 36 (23.8%) of the patients were diagnosed as having PMI. The incidence of a composite of cardiovascular events within 30 days after surgery, including myocardial infarction, stroke, worsening heart failure, atrial fibrillation and pulmonary embolism, was significantly higher in patients with PMI than in patients without PMI (odds ratio (OR) 9.25, P<0.001, 95% confidence interval (CI) 2.65-32.3). Multivariate analysis revealed that left ventricular diastolic dysfunction defined by echocardiography was independently associated with PMI (OR: 3.029, 95% CI: 1.341-6.84, P=0.008). CONCLUSIONS: PMI is frequently observed in elderly patients undergoing non-cardiac surgery. Diastolic dysfunction is an independent predictor of PMI.
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Toda et al. (2017) conducted a cohort in Elderly patients with preserved ejection fraction undergoing non-cardiac surgery (n=151). Left ventricular diastolic dysfunction vs. Without left ventricular diastolic dysfunction was evaluated on Perioperative myocardial injury (PMI) (OR 3.029, 95% CI 1.341-6.84, p=0.008). Left ventricular diastolic dysfunction was independently associated with an increased risk of perioperative myocardial injury in elderly patients undergoing non-cardiac surgery (OR 3.029).
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