Diastolic Function Assessment in Cardiac Surgery

Left ventricular diastolic dysfunction is increasingly recognised as a key determinant of perioperative risk and postoperative recovery in cardiac surgery. Unlike systolic performance, which is quantified by ejection fraction, diastolic function encompasses myocardial relaxation, chamber compliance and filling pressures. In the cardiac theatre, accurate assessment of diastolic parameters guides fluid management, inotropic support and weaning from cardiopulmonary bypass. Transthoracic and transoesophageal echocardiography offer transmitral flow analysis, tissue Doppler imaging and propagation velocity measurements to grade diastolic dysfunction and estimate left atrial pressure. Grading systems endorsed by international societies classify dysfunction into mild, moderate and severe categories, reflecting progressive impairment of relaxation and rising filling pressures. Intraoperative challenges such as positive‐pressure ventilation, anaesthetic depth and volume shifts may alter load‐dependent indices, demanding a nuanced interpretation. Recognising diastolic dysfunction preoperatively improves risk stratification for valve procedures and coronary revascularisation, while its intraoperative monitoring helps to prevent low‐cardiac‐output states, acute pulmonary oedema and prolonged ventilation. The integration of real‐time echocardiographic assessment into perioperative pathways underpins precision management and aims to reduce morbidity and length of stay after cardiac surgery worldwide.

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Diastolic Function Assessment in Cardiac Surgery publication trend

The graph below shows the total number of articles in diastolic function assessment in cardiac surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Transmitral E-wave velocity (E): The early diastolic peak flow across the mitral valve reflecting rapid ventricular filling.

Mitral annulus velocity (e′): The early diastolic motion of the mitral annulus measured by tissue Doppler imaging, indicative of myocardial relaxation.

E/e′ ratio: A Doppler-derived metric estimating left ventricular filling pressure by comparing transmitral flow to annular motion.

Propagation velocity (Vp): The speed at which blood travels into the ventricle during early filling, measured by colour M-mode Doppler.

Diastolic dysfunction grading: Classification of diastolic impairment into grades I–III based on echocardiographic parameters of relaxation and filling pressures.

References

1. Preoperative diastolic function predicts the onset of left ventricular dysfunction following aortic valve replacement in high-risk patients with aortic stenosis. Critical Care (2010).
2. Practical approach to diastolic dysfunction in light of the new guidelines and clinical applications in the operating room and in the intensive care. Annals of Intensive Care (2018).
3. Diastolic dysfunction is common and predicts outcome after cardiac surgery. Journal of Cardiothoracic Surgery (2018).
4. Echocardiographic Measures of Diastolic Function Are Preload Dependent during Triggered Positive Pressure Ventilation: A Controlled Crossover Study in Healthy Subjects. Critical Care Research and Practice (2012).
5. The effects of an IV fluid bolus on mitral annular velocity and the assessment of diastolic function: a prospective non-randomized study. BMC Anesthesiology (2024).