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January 10, 2022Open Access

Pre-Operative Point-of-Care Assessment of Left Ventricular Diastolic Dysfunction, an Observational Study

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Why the study?

LV diastolic dysfunction is an acknowledged peri-operative risk factor, but whether a simplified echocardiographic method using e' and E/e' can accurately identify and grade it pre-operatively needed evaluation.

Does a simplified echocardiographic method using e’ and E/e’ accurately identify left ventricular diastolic dysfunction in pre-operative ambulatory surgical patients compared to comprehensive assessment?

Population

96 consecutively included ambulatory surgical patients

Comparison

Simplified echocardiographic assessment using e' and E/e' vs comprehensive assessment

Design

Prospective observational study

Authors

YSYlva StenbergYRYlva RhodinALAnne Lindberg

Discussion

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Member takes

Overview

High NPV may aid ruling out pre-op diastolic dysfunction; leaves open validation and outcome impact in prospective studies.

Structured PICO

Does a simplified echocardiographic method using e’ and E/e’ accurately identify left ventricular diastolic dysfunction in pre-operative ambulatory surgical patients compared to comprehensive assessment?

P
Population
96 ambulatory surgical patients, ≥18 years of age, scheduled for ambulatory surgery at a day-surgery unit at a county hospital in Sweden. Mean age 67±9 years (with diastolic dysfunction) vs 51±13 years (without diastolic dysfunction).
I
Intervention
Simplified point-of-care echocardiographic assessment using tissue Doppler e’-velocities and E/e’ ratio.
C
Comparator
Comprehensive echocardiographic assessment of left ventricular diastolic dysfunction according to 2009 American Society of Echocardiography guidelines.
O
Outcome
Accuracy of e’-velocities to discriminate patients with diastolic dysfunction (measured by AUROC, positive predictive value, negative predictive value, and test efficiency).surrogate

A simplified point-of-care echocardiographic approach using tissue Doppler e’-velocities has a high negative predictive value to rule out pre-operative left ventricular diastolic dysfunction, though it may overestimate severity when combined with E/e’.

Limitations

  • Small sample size
  • Single-centered observational study
  • Vast majority of included patients were women
  • Examinations conducted by expert sonographers, which may decrease applicability for less experienced observers
  • Used 2009 ASE guidelines instead of 2016 guidelines
  • No intra- and postoperative data analyzed

Cite This Study

Stenberg et al. (2022) studied this question.

synapsesocial.com/papers/6a8338abab7e78751db37a16https://doi.org/10.21203/rs.3.rs-1180111/v1
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