SHM Converge Conference Coverage

Diastolic Dysfunction Linked to Higher Cardiac Risk After Hip Fracture Surgery

Kate Young

Key Highlights

  • Patients with ≥ two abnormal diastolic echocardiographic parameters had significantly higher rates of postoperative major adverse cardiac events (MACE; 23.9% vs 8.6%), 1-year mortality (31.3% vs 13.6%), and 2-year mortality (43.3% vs 19.8%).
  • Diastolic dysfunction is a strong, independent predictor of MACE and mortality in this population.

In a retrospective cohort study of patients undergoing hip fracture surgery, those with multiple abnormal diastolic echocardiographic parameters were found to be at significantly increased risk for postoperative MACE and long-term mortality. Notably, 23.9% of patients with two or more abnormal diastolic measures experienced MACE compared with 8.6% of those with one or none. Similarly, 1-year and 2-year mortality rates were substantially higher in this high-risk group. The study authors presented their results at the Society of Hospital Medicine Converge in Las Vegas, NV.

The impetus for this study lies in the recognition that diastolic dysfunction is a known independent predictor of adverse cardiac events following noncardiac surgery. However, its role specifically in hip fracture surgery—a setting marked by advanced age and high comorbidity burden—has not been well defined. Moreover, previous investigations have narrowly focused on the E/e’ ratio, often omitting other relevant parameters such as tricuspid regurgitant velocity (TRV) and left atrial volume index (LAVI).

data from study

Researchers reviewed records of 148 patients who underwent hip fracture repair at a single center between April 2016 and June 2021. Inclusion required a recent echocardiographic study. Diastolic dysfunction was assessed using three parameters: E/e’ ratio >14, TRV >2.8 m/sec, and LAVI >34 mL/m². Patients were stratified into two groups based on the number of abnormal values—either 0–1 or 2–3. The primary outcome was the incidence of postoperative MACE, while 1-year and 2-year mortality served as secondary outcomes.

Patients in the 2–3 abnormal parameter group had markedly worse outcomes across all endpoints. MACE occurred in nearly a quarter of this cohort, with 1- and 2-year mortality approaching one-third and nearly half, respectively. These individuals also presented with more comorbidities such as ischemic heart disease, atrial fibrillation, pulmonary hypertension, and chronic kidney disease.

“A higher proportion of abnormal diastolic parameters including E/e’ ratio, TRV and LAVI is associated with an increased risk of postoperative MACE, 1-year, and 2-year mortality after hip fracture surgery,” the authors concluded. “Appraisal of these diastolic indices may help identify hip fracture patients at highest risk for MACE and open avenues for better preoperative optimization and postoperative management.”

Reference:
Caruso JJ, Weiss D, Mazimba S, et al. Association of abnormal echocardiographic diastolic parameters and postoperative major adverse cardiac events and mortality in patients undergoing hip fracture surgery. Presented at: Society of Hospital Medicine Converge; 2025; Las Vegas, NV. Accessed April 22, 2025. https://shmconverge.hospitalmedicine.org/