A Practical Approach to Echocardiographic Assessment of Perioperative Diastolic Dysfunction

The Doppler assessment of diastolic dysfunction (DD) is not part of a standard comprehensive intraoperative echocardiographic examination. Although the reasons may be many, the lack of a simplified algorithm for the assessment of DD specific to the perioperative arena, the implications of this diagnosis on clinical care, and the absence of therapeutic options are some of the commonly cited reasons. In this article, the authors address these possible reasons for the lack of routine application of Doppler indices to assess perioperative DD. The authors have chosen to highlight some of the most common conceptual questions, which often have been raised by anesthesiologists, and attempted to suggest answers. Drawing from their experience and data, the authors propose a simplified algorithm for the application of Doppler to assess and diagnose DD with an individualized and a mechanistic approach. The proposed algorithm is from within the premise of the published guidelines and attempts to simplify the perioperative approach. The authors hope this approach will be simple enough for routine application to affect therapy and a tangible change in outcome. The authors suggest that knowledge of left atrial size is valuable as a marker for persistently increased left ventricular end-diastolic pressure and its possible role in risk stratification.