Relationship Between Preoperative Left Ventricular Diastolic Dysfunction And Adverse Prognosis

Objective: With Po Pulation ageing,the Prevalence of left ventricular diastolic dysfunction increased,and Patients with left ventricular diastolic dysfunction were diagnosed and graded by Preo Perative echocardiogra Phy examination,to investigate the relationshi P between Preo Perative left ventricular diastolic dysfunction and Posto Perative Prognosis in Patients undergoing non cardiac surgery.Methods : After obtaining a PProval from the ethics committee of the Affiliated Hos Pitals of Guilin Medical university,according to the 2016 echocardiogra Phy guidelines,a total of 606 non-cardiac surgical Patients were included in the retrospective analysis,they were selected from 2020-01-01 st to2020-12-31 st who underwent preoperative transthoracic echocardiogra Phy examination and were diagnosed as having left ventricular diastolic dysfunction.according to the guidelines,Patients with diastolic dysfunction were divided into three groups: group A(first-degree left ventricular diastolic dysfunction),group B(second-degree left ventricular diastolic dysfunction),and group C(thirddegree left ventricular diastolic dysfunction).Then basic information(sex,age,body mass index),Past medical history(hy Pertension,diabetes,coronary heart disease,chronic kidney disease),Preo Perative examination(liver function,renal function),imaging examination(CT of the lungs),electrocardiogram,Transthoracic echocardiogra Phy(E、A、e’,E/A、E/e’,LVEF)were collected in the clinical case system.From the anesthesia system,we can collect Intrao Perative condition,including the level of o Peration,the ty Pe of anesthesia,the duration of anesthesia,the amount of infusion,the use of Positive and negative vasoactive drugs,whether the overall heart rate during the o Peration was lower than 60 beats Per minute,whether the heart rate was raised by atro Pine during the o Peration,whether the overall diastolic Pressure during the o Peration was lower than 60 mmhg,whether the blood Pressure decreased within 10 minutes after anesthesia induction,and whether the blood Pressure fluctuated during the o Peration.at last,according to the course of disease,consultation records,examination results,imaging results and color Do PPler ultrasound results,diagnose adverse outcomes(myocardial infarction,cerebral infarction,heart failure,res Piratory failure,acute kidney injury,Pleural effusion,hy Po Proteinemia).after collecting and analyzing the data,the high risk factors of bad Prognosis were identified,and the relationshi P between the classification of cardiac diastolic dysfunction and bad Prognosis was determined.Results: There were no significant differences in Preoperative basical information(sex,age,body mass index,anamnesis,LVEF),intraoperative condition(duration of anesthesia,classification of o Peration,volume of fluid replacement,overall heart rate < 60beats/minute,use of atro Pine to increase heart rate and blood Pressure and vascular activity),Postoperative bad prognosis(myocardial infarction,respiratory failure,cerebral infarction,Pleural effusion,hypoproteinemia)among the three groups(P > 0.05),The incidence of Postoperative heart failure in group B was significantly higher than that in group A(P < 0.05),and that in group C was significantly higher than that in group B(P < 0.05).The incidence of Postoperative acute renal injury in group B was significantly higher than that in Group A,and that in group C was significantly higher than that in group B(P <0.05).The incidence of Postoperative overall Poor Prognosis in group B was significantly higher than that in group A,and that in group C was significantly higher than that in group A(P < 0.05).Logistic regression analysis showed that the grade of diastolic dysfunction was associated with an increased risk of Postoperative heart failure(OR,4.28;95% CI,3.13-5.24;P: 0.001),it was also associated with an increased risk of acute renal injury(OR,2.39;95% CI,1.32-4.33;P: 0.004).Conclusions: The adverse Prognosis was 24% in Patients with left ventricular diastolic dysfunction,and the higher the left ventricular diastolic dysfunction grade was,the higher the incidence of Postoperative heart failure and acute renal injury was.