Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery

Madhav Swaminathan, Alina Nicoara, Barbara G. Phillips-Bute, Nicolas Aeschlimann, Carmelo A. Milano, G. Burkhard MacKensen, Mihai V. Podgoreanu, Eric J. Velazquez, Mark Stafford-Smith, Joseph P. Mathew, James A. Blumenthal, Solomon Aronson, J. Mauricio Del Rio, Katherine P. Grichnik, Steven E. Hill, Andre Motie, Mark F. Newman, Ian J. Welsby, William D. White, Bonita L. FunkRoger L. Hall, Gladwell Mbochi, Tiffany Bisanar, Prometheus T. Solon, Peter Waweru, Carolyn M. Thompson, Karen L. Clemmons, Jacquelane Libed, Yanne Toulgoat-Dubois, Michael A. Babyak, Daniel B. Mark, Michael H. Sketch, Ellen R. Bennett, Carmelo Graffagnino, Daniel T. Laskowitz, Warren J. Strittmatter, Kathleen A. Welsh-Bohmer, Kevin Collins, Greg Smigla, Ian Shearer, Thomas A. D'Amico, Mark Berry, R. Duane Davis, Jeffrey Gaca, Donald D. Glower, David Harpole, G. Chad Hughes, Shu S. Lin, Andrew Lodge, Mark Onaitis, Peter K. Smith, Betty Tong

Research output: Contribution to journalArticlepeer-review

82 Scopus citations


Background: Inclusion of a measure of left ventricular diastolic dysfunction (LVDD) may improve risk prediction after cardiac surgery. Current LVDD grading guidelines rely on echocardiographic variables that are not always available or aligned to allow grading. We hypothesized that a simplified algorithm involving fewer variables would enable more patients to be assigned a LVDD grade compared with a comprehensive algorithm, and also be valid in identifying patients at risk of long-term major adverse cardiac events (MACE). Methods: Intraoperative transesophageal echocardiography data were gathered on 905 patients undergoing coronary artery bypass graft surgery, including flow and tissue Doppler-based measurements. Two algorithms were constructed to categorize LVDD: a comprehensive four-variable algorithm, A, was compared with a simplified version, B, with only two variables - transmitral early flow velocity and early mitral annular tissue velocity - for ease of grading and association with MACE. Results: Using algorithm A, only 563 patients (62%) could be graded, whereas 895 patients (99%) received a grade with algorithm B. Over the median follow-up period of 1,468 days, Cox modeling showed that LVDD was significantly associated with MACE when graded with algorithm B (p = 0.013), but not algorithm A (p = 0.79). Patients with the highest incidence of MACE could not be graded with algorithm A. Conclusions: We found that an LVDD algorithm with fewer variables enabled grading of a significantly greater number of coronary artery bypass graft patients, and was valid, as evidenced by worsening grades being associated with MACE. This simplified algorithm could be extended to similar populations as a valid method of characterizing LVDD.

Original languageEnglish
Pages (from-to)1844-1850
Number of pages7
JournalAnnals of Thoracic Surgery
Issue number6
StatePublished - Jun 2011

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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