Association of abnormal echocardiographic diastolic parameters and postoperative major adverse cardiac events and mortality in patients undergoing hip fracture surgery: a retrospective cohort study.

Abstract

Background: Perioperative diastolic dysfunction has been proposed as an independent predictor of postoperative major adverse cardiac events (MACE) after noncardiac surgery. However, prior studies have largely focused on elective procedures and employed heterogeneous echocardiographic approaches to assess diastolic function. We sought to evaluate the association between abnormal diastolic echocardiographic parameters and postoperative MACE and mortality in patients undergoing hip fracture surgery using a contemporary, multiparametric assessment of diastolic function.

Methods: In this retrospective cohort study, adult patients undergoing hip fracture repair between April 2016 and June 2021 with available preoperative transthoracic echocardiography were included. Abnormal diastolic parameters were defined as average E/e' >14, tricuspid regurgitant velocity (TRV) > 2.8 m/s, and left atrial volume index (LAVI) > 34 mL/m². Patients were stratified by the number of abnormal parameters into two groups: 0-1 abnormal versus 2-3 abnormal. The primary outcome was postoperative MACE, defined as myocardial infarction, heart failure, pulmonary edema, or death within 30 days of surgery. Secondary outcomes included 1-year and 2-year all-cause mortality.

Results: Among 148 patients included in the analysis, postoperative MACE occurred in 15.5%. Patients with 2-3 abnormal diastolic parameters experienced higher rates of MACE compared with those with 0-1 abnormal parameter (23.9% vs. 8.6%, P = 0.011). One-year and two-year mortality were also higher in the 2-3 abnormal parameter group (31.3% vs. 13.6%, P = 0.009; and 43.3% vs. 19.8%, P = 0.002, respectively). Kaplan-Meier survival analysis demonstrated lower survival among patients with multiple abnormal diastolic parameters, with separation of survival curves evident early in the postoperative period and persisting throughout follow-up, although the overall time-to-event analysis did not reach statistical significance.

Conclusions: In patients undergoing hip fracture surgery, a higher burden of abnormal echocardiographic diastolic parameters is associated with increased risk of postoperative MACE and higher short- and intermediate-term mortality. The early separation of survival curves suggests that abnormal diastolic parameters identify patients at heightened risk during the immediate postoperative period, highlighting a potentially important window for targeted perioperative risk stratification and management.