Erlotinib clinical trial Second, Vp might underestimate the severity of diastolic dysfunction in cases presenting LV chamber dilation due to swirlings of the inflow along the LV wall [19,34]. Since less than 15% of our patients presented low LV ejection, we presume that low Vp values correctly reflect impairments in LV relaxation and filling. Third, although increased LV wall thickness was documented in all patients, we did not examine the influence of LV geometry (for example, excentric or concentric hypertrophy, remodelling) and plasma biomarkers of cardiac distension (for example, brain natriuretic peptides (BNP) on LV diastolic function. Interestingly, several reports have stressed the negative impact of concentric LV geometries (with or without enlarged cardiac mass) and of elevated BNP levels on in-hospital mortality and early cardiac complications [40-42].

ConclusionsThis study provides the first evidence that diastolic dysfunction as defined by Vp <40 cm/s, in addition to advanced age and prolonged ischemic time, identifies patients at risk of LV dysfunction after valvular aortic surgery. Clinicians should anticipate a greater impact of perioperative TEE to identify high-risk cardiac patients while improving fluid and inotropic/lusitropic drug treatments. The association of preoperative diastolic dysfunction with adverse cardiac outcome begs the question as to whether trials of specific perioperative strategies to improve LV relaxation and filling patterns should be considered in patients undergoing aortic valve surgery.

Key messages? Advanced age, preoperative LV diastolic dysfunction and prolonged aortic clamping time are significant predictors of LV dysfunction following CPB requiring inotropic support in patients undergoing valve replacement for aortic stenosis.? Among several echocardiographic parameters, transmitral flow propagation velocity (Vp) less than 40 cm/sec best identified patients at higher risk of LV dysfunction after CPB and was associated with more frequent cardiac complications in the ICU.AbbreviationsBNP: brain natriuretic peptides; CI: confidence interval; Drug_discovery CPB: cardiopulmonary bypass; DT: deceleration time; E’ and A’: early and late diastolic velocities of the mitral annulus; EDA: end-diastolic area; ESA: end-systolic area; FAC: fractional area change; IABP: intra-aortic balloon pump; IVRT: isovolumic relaxation time; LV: left ventricular; MAP: mean arterial pressure; ORs: odds ratios; PWT: posterior wall thickness; ROC: receiver-operator-characteristic; S: D and Ar: peak systolic, diastolic and atrial reversal velocities of pulmonary venous flow; TDI: tissue Doppler imaging; TEE: transoesophageal echocardiography; Vp: transmitral flow propagation velocity.

Competing interestsThe authors declare that they have no competing interests.