Preoperative elevated E/e’ (≥ 15) with preserved ejection fraction is associated with the development of postoperative heart failure in intermediate-risk non-cardiac surgical patients
Midoriko Higashi, Kenji Shigematsu, Kenji Tominaga, Kazuya Murayama, daisuke Seo, Toshikazu Tsuda, Gen Maruta, Kohei Iwashita, Ken Yamaura
Abstract
Abstract Purpose Left ventricular diastolic dysfunction is an independent risk factor for adverse cardiovascular morbidities and mortalities in cardiovascular and high-risk surgical patients. However, there were only a few investigations among intermediate-risk surgical patients. This study aimed to investigate postoperative heart failure (HF) in intermediate-risk surgical patients who had preoperative diastolic dysfunction with preserved ejection fraction (EF). Methods Consecutive patients underwent intermediate-risk surgery between January 2016 and December 2018 were retrospectively evaluated. Patients with preserved EF were divided into three groups using one of the parameters of diastolic function: the ratio of early diastolic filling velocity to the peak diastolic velocity of mitral medial annulus ( E / e ’) ≥ 15, E / e ’ between 8 and 15, and E / e ’ < 8. Postoperative HF was defined as clinical symptoms and radiological evidence and low SpO 2 less than 93%. The primary outcome was the incidence of postoperative HF and its relation to preoperative E / e ’. Chi-squared test, unpaired t test with Welch’s correction, and multivariate logistic regression were used for analysis. Results In total, 965 patients were included in the final analysis. Postoperative HF developed in 36/965 (3.7%) patients with preserved EF. The incidence of postoperative HF was stratified according to the E / e ’, and the rates of HF occurrence in patients with E / e ’ < 8, 8–15, and ≥ 15 were 1.8%, 2.7%, and 15%, respectively ( P < 0.01). Conclusion Preoperative elevated E / e ’ (≥ 15) was associated with the development of postoperative HF in intermediate-risk surgical patients with preserved EF.