Search

Background: Although moderate to severe diastolic dysfunction (DD) seems to be associated with poor prognosis after isolated coronary bypass surgery, the impact of mild DD has not been investigated extensively in this group of patients., Aim: We evaluated the prognostic implication of mild left ventricular (LV) DD on outcome after isolated coronary bypass surgery in patients with preserved LV systolic function., Methods: Data from 650 patients undergoing isolated coronary bypass surgery and having records for LV diastolic function between January 2009 and August 2011 was collected retrospectively. DD was classified as mild (grade 1, impaired relaxation), moderate (grade 2, decreased compliance) or severe (grade 3-4, restrictive pattern) depending on mitral inflow wave, tissue Doppler imaging, and pulmonary vein flow wave. Patients with baseline rhythm other than sinus, moderate or severe valvular dysfunction, moderate or severe diastolic dysfunction, and LV ejection fraction lower than 50% were excluded. A total of 472 patients were identified within the database fulfilling the eligibility criteria for this analysis and stratified according to the echocardiographic findings as follows: group 1 comprised patients with normal diastolic function (n = 168); and group 2 was made up of patients with mild DD (impaired relaxation) (n = 304). These groups were compared for perioperative morbidity and mortality., Results: The preoperative variables were comparable between groups. The outcome parameters of group 1 was similar compared to group 2 in terms of need for inotropic support (20.2% vs. 16.2%), intra-aortic balloon pump usage (0% vs. 1.4%), mechanical ventilation time (8.94 ± 0.96 h vs. 10.0 ± 0.89 h), reintubation rate (1.8% vs. 1.4%), intensive care unit stay time (24.1 ± 1.4 hvs. 26.2 ± 1.9 h), postoperative renal failure rate (0% vs. 0.3%), postoperative atrial fibrillation rate (10.1% vs. 11.2%), length of hospital stay (7.19 ± 0.45 vs. 6.57 ± 0.14 days), hospital readmission rate (3.1% vs. 3.1%), and mortality (0% vs. 1.6%)., Conclusions: The results from this study indicate that mild LV DD is not associated with adverse outcome after coronary bypass surgery in patients with preserved LV systolic function, thus should not be considered as a preoperative risk factor.

Background: Pulmonary hypertension is caused by a heterogenous group of disorders with diverse pathophysiological mechanisms, with ultimate structural changes in the pulmonary vascular bed. Platelet activation plays an important role in the development of pulmonary arterial hypertension, while it is unknown whether it contributes to pathogenesis in other conditions. We aimed to investigate platelet activation in different causes of pulmonary hypertension by means of mean platelet volume measurement., Methods: A total of 67 patients with different causes of pulmonary hypertension, and 31 controls, were retrospectively reviewed. Patients with pulmonary hypertension were further grouped according to underlying disease, including pulmonary arterial hypertension, pulmonary hypertension due to left ventricular failure, and pulmonary hypertension due to chronic obstructive pulmonary disorder. All patients and controls past medical data, admission echocardiograms and complete blood counts were reviewed., Results: Patients with pulmonary hypertension had higher mean platelet volume levels compared to healthy controls (8.77 ± 1.18 vs 7.89 ± 0.53; p < 0.001), and statistical significance was still present when pulmonary arterial hypertension patients were not included in the pulmonary hypertension group (8.59 ± 1.23 vs 7.89 ± 0.53; p < 0.001). Among patients with pulmonary hypertension, the pulmonary arterial hypertension group and the pulmonary hypertension due to left ventricular failure group had higher mean platelet volumes compared to healthy controls. Mean platelet volume did not correlate with pulmonary artery pressure., Conclusions: Our results indicate that mean platelet volume is not only elevated in pulmonary arterial hypertension, but also due to other causes of pulmonary hypertension.