Deepak Prakash Borde1, Devarakonda Bhargava Venkata2, Shreedhar Joshi3, Amish Jasapara4, Pooja Joshi1, Balaji Asegaonkar1
1 Cardiac Anaesthesia, Ozone Anaesthesia Group, Aurangabad, Maharashtra, India
2 Department of Cardiothoracic Anaesthesiology, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
3 Cardiac Anaesthesia, Narayana Institute of Cardiac Sciences, Narayana Hospitals, Bengaluru, Karnataka, India
4 Cardiac Anaesthesia, Fortis Hospitals, Mumbai, Maharashtra, India
Introduction: Left ventricular (LV) diastolic dysfunction is common on preoperative screening among patients undergoing surgery. There is no simple screening test at present to suspect LV diastolic dysfunction. This study was aimed to test the hypothesis, whether elastic recoil signal (ERS) on tissue Doppler imaging of mitral annulus (MA TDI) can be used as a qualitative test to differentiate patients from normal LV diastolic function versus patients with LV diastolic dysfunction.
Methods: This was a prospective cross-sectional observational study of patients admitted for elective surgeries. Normal diastolic function and categorization of LV diastolic dysfunction into severity grades I, II, or III were performed as per the American Society of Echocardiography/ European Associationof Cardio Vascular Imaging (ASE/EACVI) recommendations for LV diastolic dysfunction.
Results: There were 41 (61%) patients with normal LV diastolic function and 26 (39%) patients with various grades of LV diastolic dysfunction. In 38 out of 41 patients with normal LV diastolic function, the characteristic ERS was identified. The ERS was absent in all the patients with any grade of LV diastolic dysfunction. Consistency of identification of ERS on echocardiography was tested with a good interobserver variability coefficient of 0.94 (P-value <0.001). The presence of ERS demonstrated an excellent differentiation to rule out any LV diastolic dysfunction with an area under the receiver operating characteristics curve (AUROC) of 0.96 (CI 0.88–0.99; P value <0.001).
Conclusions: To conclude, in a mixed surgical population, the anesthetist could successfully assess LV diastolic dysfunction in the preoperative period and the characteristic ERS on MA TDI signal can be used as a qualitative test to differentiate patients from normal LV diastolic function versus patients with LV diastolic dysfunction using the transthoracic echocardiography (TTE).
Deepak Prakash Borde
Department of Cardiac Anaesthesia, Ozone Anaesthesia Group, First Floor, OPD Wing, United CIIGMA Hospital, Aurangabad - 431 001, Maharashtra
Source of Support: None, Conflict of Interest: None
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