Association Between Diastolic Dysfunction and Postoperative Heart Failure in Non-cardiac Surgeries

Background: Cardiovascular complications are a leading cause of morbidity and mortality following non-cardiac surgery. Although the association between systolic dysfunction and perioperative outcomes is well recognised, the prognostic significance of diastolic dysfunction remains underexplored and is not incorporated into risk models. This study investigated whether preoperative diastolic dysfunction is associated with adverse in-hospital outcomes following non-cardiac surgery. Methods: This retrospective cohort study included 3,882 adults who underwent non-cardiac surgery between 2011 and 2021 and had preoperative echocardiographic assessment of diastolic function. Diastolic dysfunction was graded per 2016 American Society of Echocardiography guidelines and categorised as normal/grade 1 (normal left-sided filling pressure [NLFP]) or grade 2/3 (elevated left-sided filling pressure [ELFP]). The primary outcome was a composite of in-hospital mortality and acute heart failure. Results: The primary outcome occurred in 22.3% of patients with ELFP and 11.6% of patients with NLFP (OR 2.1; 95% CI [1.7-2.6]; p<0.001). In-hospital mortality was 9.1% in the ELFP group and 4.2% in the NLFP group (OR 2.2; 95% CI [1.6-3.0]). Pulmonary oedema (3.8% versus 0.7%; OR 4.9; 95% CI [2.9-8.4]), furosemide use (12.9% versus 5.5%; OR 2.5; 95% CI [1.9-3.2]) and vasoactive medication administration (7.9% versus 5.4%; OR 1.5; 95% CI [1.1-2]) were more frequent in the ELFP group. These associations persisted after adjustment for echocardiographic and clinical parameters. Stratified analysis showed the association was strongest in intermediate- to high-risk surgeries. Conclusion: Diastolic dysfunction is independently associated with adverse postoperative outcomes in non-cardiac surgery. Incorporating diastolic parameters into preoperative risk assessment may improve perioperative outcomes.