Predictive Score for Significant Diastolic Dysfunction in Patients with Morbid Obesity Undergoing Bariatric Surgery

Abstract

Background: Morbid obesity is a well-established risk factor for cardiovascular disease. Diastolic dysfunction, particularly in non-cardiac surgeries, has been associated with increased incidence of adverse cardiovascular events. This study aimed to evaluate the prevalence of diastolic dysfunction in morbidly obese patients undergoing bariatric surgery and to identify associated clinical risk factors using transesophageal echocardiography (TEE). Methods: In this prospective observational study, 113 morbidly obese patients scheduled for bariatric surgery between April 2019 and January 2023 were enrolled. Diastolic function was assessed after anesthesia induction using TEE and categorized as normal or grade I, II, or III dysfunction based on the E/e’ ratio. The primary study outcome was the prevalence of diastolic dysfunction, while secondary outcomes included identification of risk factors, development of a predictive score and evaluation of perioperative complications. Results: Diastolic dysfunction was identified in 45.1% of patients (grade I: 21.2%; grade II: 19.5%; and grade III: 4.4%). Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01 to 1.08) and continuous positive airway pressure (CPAP) use for obstructive sleep apnea (OSA) (OR, 4.22; 95% CI, 1.02 to 17.55) were significantly associated with high-grade dysfunction (grades II–III). A predictive score demonstrated high diagnostic accuracy with a cutoff of >120 points. The score was calculated as (age×2)+(coronary artery disease×51)+(chronic kidney disease×102)+(OSA without CPAP×2)+(OSA with CPAP×63). Postoperative outcomes did not differ significantly between groups. Conclusion: Diastolic dysfunction is prevalent among morbidly obese patients undergoing bariatric surgery. A predictive score exceeding 120 points may aid in identifying individuals at elevated risk.