Mondal Samhati, Faraday Nauder, Gao Wei Dong, Singh Sarabdeep, Hebbar Sachidanand, Hollander Kimberly N, Metkus Thomas S, Goeddel Lee A, Bauer Maria, Bush Brian, Cho Brian, Cha Stephanie, Ibekwe Stephanie O, Mladinov Domagoj, Rolleri Noah S, Lester Laeben, Steppan Jochen, Sheinberg Rosanne, Hensley Nadia B, Kapoor Anubhav, Dodd-O Jeffrey M
Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
J Clin Med. 2022 Jul 8;11(14):3980. doi: 10.3390/jcm11143980.
(1) Importance: Abnormal left ventricular (LV) diastolic function, with or without a diagnosis of heart failure, is a common finding that can be easily diagnosed by intra-operative transesophageal echocardiography (TEE). The association of diastolic function with duration of hospital stay after coronary artery bypass (CAB) is unknown. (2) Objective: To determine if selected TEE parameters of diastolic dysfunction are associated with length of hospital stay after coronary artery bypass surgery (CAB). (3) Design: Prospective observational study. (4) Setting: A single tertiary academic medical center. (5) Participants: Patients with normal systolic function undergoing isolated CAB from September 2017 through June 2018. (6) Exposures: LV function during diastole, as assessed by intra-operative TEE prior to coronary revascularization. (7) Main Outcomes and Measures: The primary outcome was duration of postoperative hospital stay. Secondary intermediate outcomes included common postoperative cardiac, respiratory, and renal complications. (8) Results: The study included 176 participants (mean age 65.2 ± 9.2 years, 73% male); 105 (60.2%) had LV diastolic dysfunction based on selected TEE parameters. Median time to hospital discharge was significantly longer for subjects with selected parameters of diastolic dysfunction (9.1/IQR 6.6−13.5 days) than those with normal LV diastolic function (6.5/IAR 5.3−9.7 days) (p < 0.001). The probability of hospital discharge was 34% lower (HR 0.66/95% CI 0.47−0.93) for subjects with diastolic dysfunction based on selected TEE parameters, independent of potential confounders, including a baseline diagnosis of heart failure. There was a dose−response relation between severity of diastolic dysfunction and probability of discharge. LV diastolic dysfunction based on those selected TEE parameters was also associated with postoperative cardio-respiratory complications; however, these complications did not fully account for the relation between LV diastolic dysfunction and prolonged length of hospital stay. (9) Conclusions and Relevance: In patients with normal systolic function undergoing CAB, diastolic dysfunction based on selected TEE parameters is associated with prolonged duration of postoperative hospital stay. This association cannot be explained by baseline comorbidities or common post-operative complications. The diagnosis of diastolic dysfunction can be made by TEE.
（1）重要性：左心室（LV）舒张功能异常，无论是否诊断为心力衰竭，都是一种常见情况，可通过术中经食管超声心动图（TEE）轻松诊断。舒张功能与冠状动脉搭桥术（CAB）后住院时间的关联尚不清楚。（2）目的：确定舒张功能障碍的特定TEE参数是否与冠状动脉搭桥手术（CAB）后的住院时间相关。（3）设计：前瞻性观察研究。（4）地点：一家单一的三级学术医疗中心。（5）参与者：2017年9月至2018年6月期间接受单纯CAB且收缩功能正常的患者。（6）暴露因素：冠状动脉血运重建术前通过术中TEE评估的舒张期左心室功能。（7）主要结局和测量指标：主要结局是术后住院时间。次要中间结局包括常见的术后心脏、呼吸和肾脏并发症。（8）结果：该研究纳入了176名参与者（平均年龄65.2±9.2岁，73%为男性）；根据特定TEE参数，105名（60.2%）存在左心室舒张功能障碍。舒张功能障碍特定参数的受试者中位出院时间（9.1/四分位间距6.6 - 13.5天）显著长于左心室舒张功能正常的受试者（6.5/四分位间距5.3 - 9.7天）（p<0.001）。根据特定TEE参数存在舒张功能障碍的受试者出院概率低34%（风险比0.66/95%置信区间0.47 - 0.93），与潜在混杂因素无关，包括心力衰竭的基线诊断。舒张功能障碍严重程度与出院概率之间存在剂量反应关系。基于这些特定TEE参数的左心室舒张功能障碍也与术后心肺并发症相关；然而，这些并发症并不能完全解释左心室舒张功能障碍与住院时间延长之间的关系。（9）结论及相关性：在接受CAB且收缩功能正常的患者中，基于特定TEE参数的舒张功能障碍与术后住院时间延长相关。这种关联无法用基线合并症或常见术后并发症来解释。舒张功能障碍可通过TEE诊断。
