Left ventricular diastolic dysfunction in chronic kidney disease and anaesthesia implications

Left ventricular diastolic dysfunction is frequently noticed in patients with chronic kidney disease. Echocardiography is used to determine the presence and severity of diastolic dysfunction. In left ventricular diastolic dysfunction the ventricular diastolic distensibility, filling or relaxation is abnormal; however, the left ventricular ejection fraction may be normal or decreased. In heart failure with preserved ejection fraction, the patients have symptomatic pulmonary congestion even though the systolic ejection fraction is more than 50%. This condition is commonly associated with ventricular diastolic dysfunction. Increased incidence of major adverse cardiovascular events has been reported in surgical patients having grade III diastolic dysfunction. Peri-operatively haemodynamic instability and fluid overload in this set of patients is known to generate pulmonary oedema.