Preexisting Right Ventricular Diastolic Dysfunction and Postoperative Cardiac Complications in Patients Undergoing Nonemergency Coronary Artery Bypass Surgery

Right Ventricular Diastolic Dysfunction: “The Missing Link”

“…The authors should be commended for reporting the occurrence of RVDD in the absence of significant left heart dysfunction, pulmonary hypertension (PHTN), or RV systolic dysfunction. 32 Although RVDD previously has been reported with and without RVSD, it usually has been in association with either LVDD, left ventricular systolic dysfunction, and/or PHTN. 30,33,34 It is possible that RVDD precedes RVSD in the presence of PHTN.…”

“…[22][23][24][25][26][27][28] In this issue of Journal of Cardiothoracic and Vascular Anesthesia, Sumin et al described the occurrence of right ventricular diastolic dysfunction (RVDD) and its association with outcome. 32 Patients with left ventricular ejection fraction > 40% and without significant valvular dysfunction, arrhythmias, or respiratory failure were scheduled for nonemergent coronary artery bypass graft surgery. Based on preoperative transthoracic echocardiography and using published guidelines 5 for diagnosing RVDD, Sumin et al compared outcomes for 108 patients with preoperative RVDD (RVDD+) to 92 patients with normal RV diastolic function (RVDD-).…”

“…Based on preoperative transthoracic echocardiography and using published guidelines 5 for diagnosing RVDD, Sumin et al compared outcomes for 108 patients with preoperative RVDD (RVDD+) to 92 patients with normal RV diastolic function (RVDD-). 32 RV diastolic function was assessed using transtricuspid valve flows (Et, At, Et/At) and transtricuspid valve lateral annular tissue Doppler (TDI) imaging (et', at'). RV systolic function was assessed using TDI (st'), tricuspid annular plane systolic excursion (TAPSE), and myocardial performance index.…”

“…The authors associated RVDD with PHF, which was defined by mixed venous oxygenations and blood pressures. 32 The referenced article reporting these criteria reported that PHF alone was not associated with outcome, but when combined with an elevated N-terminal proÀB-type natriuretic peptide, long-term (but not short-term) mortality was more likely. 36 In the present study, clinical outcomes (secondary outcomes) were not affected by the presence of RVDD, and there was no reporting of intensive care unit or hospital length of stay or long-term outcomes.…”

“…The authors did not evaluate cardiac output, chamber pressure, or chamber size, nor did they provide reference measures for RV diastolic and systolic function. 32 Although left ventricular ejection fraction was quantified during preoperative twodimensional echocardiography, there was no similar measure performed regarding RV systolic function. 32 Assessment of RV systolic function relied on TAPSE and TDI, two longitudinal measures that have that have had mixed predictive outcome value for patients and may not be reflective of overall systolic performance.…”