1
|
McIlroy DR, Wettig P, Burton J, Neylan A, French B, Lin E, Hastings S, Waldron BJF, Buckland MR, Myles PS. Poor Agreement Between Preoperative Transthoracic Echocardiography and Intraoperative Transesophageal Echocardiography for Grading Diastolic Dysfunction. Anesth Analg 2024; 138:123-133. [PMID: 38100804 DOI: 10.1213/ane.0000000000006734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND Guidelines for the evaluation and grading of diastolic dysfunction are available for transthoracic echocardiography (TTE). Transesophageal echocardiography (TEE) is used for this purpose intraoperatively but the level of agreement between these 2 imaging modalities for grading diastolic dysfunction is unknown. We assessed agreement between awake preoperative TTE and intraoperative TEE for grading diastolic dysfunction. METHODS In 98 patients undergoing cardiac surgery, key Doppler measurements were obtained using TTE and TEE at the following time points: TTE before anesthesia induction (TTEawake), TTE following anesthesia induction (TTEanesth), and TEE following anesthesia induction (TEEanesth). The primary endpoint was grade of diastolic dysfunction categorized by a simplified algorithm, and measured by TTEawake and TEEanesth, for which the weighted κ statistic assessed observed agreement beyond chance. Secondary endpoints were peak early diastolic lateral mitral annular tissue velocity (e'lat) and the ratio of peak early diastolic mitral inflow velocity (E) to e'lat (E/e'lat), measured by TTEawake and TEEanesth, were compared using Bland-Altman limits of agreement. RESULTS Disagreement in grading diastolic dysfunction by ≥1 grade occurred in 43 (54%) of 79 patients and by ≥2 grades in 8 (10%) patients with paired measurements for analysis, yielding a weighted κ of 0.35 (95% confidence interval [CI], 0.19-0.51) for the observed level of agreement beyond chance. Bland-Altman analysis of paired data for e'lat and E/e'lat demonstrated a mean difference (95% CI) of 0.51 (-0.06 to 1.09) and 0.70 (0.07-1.34), respectively, for measurements made by TTEawake compared to TEEanesth. The percentage (95% CI) of paired measurements for e'lat and E/e'lat that lay outside the [-2, +2] study-specified boundary of acceptable agreement was 36% (27%-48%) and 39% (29%-51%), respectively. Results were generally robust to sensitivity analyses, including comparing measurements between TTEawake and TTEanesth, between TTEanesth and TEEanesth, and after regrading diastolic dysfunction by the American Society of Echocardiography (ASE)/European Association of CardioVascular Imaging (EACVI) algorithm. CONCLUSIONS There was poor agreement between TTEawake and TEEanesth for grading diastolic dysfunction by a simplified algorithm, with disagreement by ≥1 grade in 54% and by ≥2 grades in 10% of the evaluable cohort. Future studies, including comparing the prognostic utility of TTEawake and TEEanesth for clinically important adverse outcomes that may be a consequence of diastolic dysfunction, are needed to understand whether this disagreement reflects random variability in Doppler variables, misclassification by the changed technique and physiological conditions of intraoperative TEE, or the accurate detection of a clinically relevant change in diastolic dysfunction.
Collapse
Affiliation(s)
- David R McIlroy
- From the Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee
- Department of Anaesthesia & Perioperative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pagen Wettig
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jedidah Burton
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Aimee Neylan
- Department of Anesthesia & Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Enjarn Lin
- Department of Anaesthesia & Perioperative Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Anesthesia & Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Stuart Hastings
- Department of Anaesthesia & Perioperative Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Anesthesia & Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Benedict J F Waldron
- Department of Anesthesia & Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark R Buckland
- Department of Anesthesia & Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Paul S Myles
- Department of Anaesthesia & Perioperative Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Anesthesia & Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Braksator M, Jachymek M, Witkiewicz K, Witkiewicz W, Peregud-Pogorzelska M, Kotfis K, Kaźmierczak J, Brykczyński M. The Impact of Left Ventricular Diastolic Dysfunction on Respiratory Adverse Events in Cardiac Surgery Patients-An Observational Prospective Single-Center Study. J Clin Med 2023; 12:4960. [PMID: 37568361 PMCID: PMC10419440 DOI: 10.3390/jcm12154960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Left ventricular diastolic dysfunction (LV DD) is the most dominant cause of heart failure with preserved ejection fraction (HFpEF) worldwide. This pathological condition may contribute to postcapillary pulmonary hypertension (pcPH) development. Hypoxemia, often observed in pcPH, may significantly negatively impact the course of hospitalization in patients after cardiac surgery. The aim of our study was to investigate the impact of LV DD on the frequency of postoperative respiratory adverse events (RAE) in patients undergoing Coronary Artery Bypass Grafting (CABG). METHODS The left ventricular (LV) diastolic function was assessed in 56 consecutive patients admitted for CABG. We investigated the relationship between LV DD and postoperative respiratory adverse events (RAE) in groups with normal LV diastolic function and LV DD stage I, II, and III. RESULTS Left ventricular diastolic dysfunction stage I was observed in 11 patients (19.6%) and LV DD stage II or III in 19 patients (33.9%). Arterial blood partial pressure of oxygen (PaO2) to the fraction of inspired oxygen (FiO2) index during postoperative mechanical ventilation was significantly lower in LV DD stage II or III than in the group with normal LV diastolic function. Patients with DD stage II or III had a higher occurrence of postoperative pneumonia than the group with normal LV diastolic function. CONCLUSIONS Left ventricular diastolic dysfunction is widespread in cardiac surgery patients and is an independent risk factor for lower minimal PaO2/FiO2 index during mechanical ventilation and higher occurrence of pneumonia.
Collapse
Affiliation(s)
- Marta Braksator
- Department of Cardiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (M.B.); (M.J.); (W.W.); (M.P.-P.); (J.K.)
| | - Magdalena Jachymek
- Department of Cardiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (M.B.); (M.J.); (W.W.); (M.P.-P.); (J.K.)
| | - Karina Witkiewicz
- Department of Pulmonology, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Wojciech Witkiewicz
- Department of Cardiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (M.B.); (M.J.); (W.W.); (M.P.-P.); (J.K.)
| | - Małgorzata Peregud-Pogorzelska
- Department of Cardiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (M.B.); (M.J.); (W.W.); (M.P.-P.); (J.K.)
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Jarosław Kaźmierczak
- Department of Cardiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (M.B.); (M.J.); (W.W.); (M.P.-P.); (J.K.)
| | - Mirosław Brykczyński
- Department of Cardiac Surgery, University of Zielona Góra, 65-417 Zielona Góra, Poland;
| |
Collapse
|
3
|
Nam K, Park YS, Kim WH. Perioperative Echocardiographic Index of Left Ventricular Filling Pressure in Cardiac Surgery. Ann Thorac Surg 2018; 107:84-91. [PMID: 30273567 DOI: 10.1016/j.athoracsur.2018.07.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 07/03/2018] [Accepted: 07/30/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The elevated preoperative ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e') as an echocardiographic index of left ventricular filling pressure is known to be associated with poor postoperative outcomes. We investigated the association between preoperative and postoperative E/e' elevation and clinical outcomes after cardiac operations. METHODS The study divided 1,353 patients who underwent cardiac operations into four groups: preoperative and postoperative E/e' ≤15 (low-low), preoperative E/e' ≤15 but postoperative E/e' >15 (low-high), preoperative E/e' >15 but postoperative E/e' ≤15 (high-low), and preoperative and postoperative E/e' >15 (high-high). Cox proportional hazard analysis was performed. Kaplan-Meier curve analysis was performed before and after propensity score matching. RESULTS The four perioperative E/e' categories were independently associated with 5-year mortality (hazard ratio, high-high vs low-low: 3.58; low-high vs low-low: 3.75; high-low vs low-low: 1.18). Kaplan-Meier curves showed that mortality was significantly different between the groups (log-rank test: high-high vs. low-low, p < 0.001; low-high vs low-low, p < 0.001). Postoperative intensive care unit and hospital lengths of stay, incidence of acute kidney injury, and 1-year mortality were significantly different. However, after propensity score matching, mortality and the incidence of postoperative acute kidney injury were significantly different only between postoperative E/e' ≤15 and E/e' >15, but not between preoperative E/e' ≤15 and E/e' >15. CONCLUSIONS Postoperative E/e' >15 was more strongly associated with mortality and acute kidney injury than preoperative E/e' >15. Measurement of the postoperative E/e' ratio may help in assessing the risk of these patients.
Collapse
Affiliation(s)
- Karam Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Sang Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|
4
|
Mukai A, Suehiro K, Fujimoto Y, Matsuura T, Tanaka K, Funao T, Yamada T, Mori T, Nishikawa K. The Sum of Early Diastolic Annulus Velocities in the Mitral and Tricuspid Valve Can Predict Adverse Events After Cardiac Surgery. J Cardiothorac Vasc Anesth 2018; 33:149-156. [PMID: 30082129 DOI: 10.1053/j.jvca.2018.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess whether a tissue Doppler imaging (TDI)-based parameter consisting of the sum of early diastolic velocities of the mitral annulus (Me') and tricuspid annulus (Te') can serve as a predictor of adverse outcomes after cardiac surgery. DESIGN Prospective, observational study. SETTING University hospital. PARTICIPANTS The study comprised 100 patients undergoing cardiac surgery. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS After anesthetic induction, transesophageal echocardiography was performed to obtain the values of the early transmitral flow velocity (E), Me', and Te'. The primary endpoint was the incidence of postoperative major organ morbidity and mortality (MOMM) events, including death, redo surgery, prolonged ventilation, stroke, sternal infection, and dialysis. Receiver operating characteristic and multivariate logistic analyses were used to examine the prognostic performance of TDI-based parameters for predicting MOMM incidence. The secondary endpoint was the incidence of death or rehospitalization for cardiovascular disease within 1 year post-discharge. TDI-based parameters were measured in 87 of the 100 patients enrolled. Me' plus Te' had better prognostic ability (area under the curve 0.771; threshold 13 cm/s; sensitivity 86.7%; specificity 64.9%) than that of Me' or E to Me' (E/Me')% and was an independent predictor of MOMM (odds ratio 0.45; 95% confidence interval 0.28-0.74, p = 0.001), whereas Me' was not. Lower Me' plus Te' (≤13 cm/s) was associated with a significantly higher incidence and earlier onset of cardiovascular events within 1 year post-discharge (p = 0.012). CONCLUSIONS Compared with Me' and E/Me', which traditionally are used for assessing diastolic function, Me' plus Te' showed better prognostic ability for both short- and long-term outcomes of cardiac surgery.
Collapse
Affiliation(s)
- Akira Mukai
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Koichi Suehiro
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan.
| | - Yohei Fujimoto
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Tadashi Matsuura
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Katsuaki Tanaka
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Tomoharu Funao
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Tokuhiro Yamada
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Takashi Mori
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Kiyonobu Nishikawa
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan
| |
Collapse
|
5
|
Metkus TS, Suarez-Pierre A, Crawford TC, Lawton JS, Goeddel L, Dodd-O J, Mukherjee M, Abraham TP, Whitman GJ. Diastolic dysfunction is common and predicts outcome after cardiac surgery. J Cardiothorac Surg 2018; 13:67. [PMID: 29903030 PMCID: PMC6003153 DOI: 10.1186/s13019-018-0744-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/31/2018] [Indexed: 12/20/2022] Open
Abstract
Background Diastolic dysfunction (DD) identified on echocardiography predicts mortality after cardiac surgery, however the most useful diastolic parameters for assessment and the association of DD with prolonged mechanical ventilation, ICU re-admission, and hospital length of stay are not established. Methods We included patients that underwent coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or a combined procedure (CAB-AVR) from 2010 to 2016, and who had preoperative transthoracic echocardiography (TTE) at our institution within 6 months of the operation. Diastolic function was graded using the transmitral E and A waves and the septal tissue Doppler velocity. We performed logistic regression to assess the association of grade of DD with a composite endpoint of death, prolonged mechanical ventilation, ICU readmission during hospitalization, and hospital length of stay longer than 14 days. Results Between 2010 and 2016, 577 patients were eligible for inclusion. DD was common, with 42% of the cohort manifesting grade II or grade III DD. Rates of death and prolonged ventilation increased across grades of DD and across quartiles of increasing LV filling pressure, assessed by the E/e’ ratio. Adjusting for age, sex, procedure, systolic and diastolic function, both systolic (odds ratio 0.68 95% CI 0.55–0.85 per inter-quartile increase in LVEF) and diastolic function (odds ratio 1.31 95% CI 1.04–1.66 per increasing DD grade) both independently predicted outcome. Conclusion Diastolic dysfunction is common among patients undergoing cardiac surgery and is associated with death, prolonged mechanical ventilation, and prolonged hospital and ICU length of stay independent of systolic dysfunction.
Collapse
Affiliation(s)
- Thomas S Metkus
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524 D2, Baltimore, MD, 21287, USA.
| | - Alejandro Suarez-Pierre
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Todd C Crawford
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer S Lawton
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lee Goeddel
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Dodd-O
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524 D2, Baltimore, MD, 21287, USA
| | - Theodore P Abraham
- Division of Cardiology, Department of Medicine, University of California, San Francisco, 505 Parnassus Ave., Suite M344 San Francisco, San Francisco, CA, USA
| | - Glenn J Whitman
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
6
|
Hur M, Nam K, Jo WY, Kim G, Kim WH, Bahk JH. Association Between Elevated Echocardiographic Index of Left Ventricular Filling Pressure and Acute Kidney Injury After Off-Pump Coronary Artery Surgery. Circ J 2017; 82:857-865. [PMID: 29212963 DOI: 10.1253/circj.cj-17-0660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The ratio of the early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e') is an echocardiographic index of mean left ventricular (LV) filling pressure. We investigated the association between the preoperative E/e' ratio and postoperative acute kidney injury (AKI) during off-pump coronary artery bypass surgery (OPCAB).Methods and Results:We reviewed 585 patients who underwent OPCAB and with preserved LV ejection fraction determined by preoperative echocardiography. AKI was determined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Multivariable logistic regression analysis was performed. E/e' was also analyzed as 3 categories (E/e' <8, 8≤E/e'≤15, and E/e' >15) and as a continuous variable. A propensity score analysis was used to match the patients with E/e' >15 and E/e' ≤15. A preoperative E/e' >15 was an independent predictor for AKI (odds ratio 3.01, 95% confidence interval 1.40-6.17). E/e' >15 was also an independent predictor for AKI when E/e' was analyzed with 3 categories or as a continuous variable. In the matched sample, the incidence of AKI and 1-year mortality was significantly higher in patients with E/e' >15. CONCLUSIONS Among patients undergoing OPCAB with preserved LV systolic function, a preoperative E/e' ratio >15 was an independent predictor of postoperative AKI. Measurement of the preoperative E/e' ratio may help to assess the risk of postoperative AKI.
Collapse
Affiliation(s)
- Min Hur
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital
| | - Karam Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital
| | - Woo Young Jo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital
| | - Gahyun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center
| | - Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital
| | - Jae-Hyon Bahk
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital
| |
Collapse
|
7
|
Effect of diastolic dysfunction on postoperative outcomes after cardiovascular surgery: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2016; 152:1142-53. [DOI: 10.1016/j.jtcvs.2016.05.057] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/29/2016] [Accepted: 05/30/2016] [Indexed: 01/08/2023]
|
8
|
Bang JY, Lee JB, Sang BH, Hoon Kim Y, Han DJ, Song JG, Hwang GS. High Left Ventricular Filling Pressure on Doppler Echocardiography Is Associated With Graft Failure and Overall Mortality Following Kidney Transplantation. J Cardiothorac Vasc Anesth 2016; 30:585-91. [DOI: 10.1053/j.jvca.2015.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Indexed: 11/11/2022]
|
9
|
Borde DP, Asegaonkar B, Apsingekar P, Khade S, Futane S, Khodve B, Kedar M, Deodhar A, Takalkar U, George A, Joshi S. Monitoring diastolic dysfunction using a simplified algorithm in patients undergoing off-pump coronary artery bypass grafting surgery. Ann Card Anaesth 2016; 19:231-9. [PMID: 27052062 PMCID: PMC4900366 DOI: 10.4103/0971-9784.179591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Context: Left ventricle diastolic dysfunction (LVDD) is gaining importance as useful marker of mortality and morbidity in cardiac surgical patients. Different algorithms have been proposed for the intraoperative grading of DD. Knowledge of the particular grade of DD has clinical implications with the potential to modify therapy, but there is a paucity of literature on the role of diastolic function evaluation during off-pump coronary artery bypass grafting (OPCABG) surgery. Aims: The aim of this study was to monitor changes in LVDD using simplified algorithm proposed by Swaminathan et al. in patients undergoing OPCABG. Settings and Design: The study was conducted in a tertiary care level hospital; this was a prospective, observational study. Subjects and Methods: Fifty consecutive patients undergoing OPCABG were enrolled. Hemodynamic and echocardiographic parameters were measured at 6 stages in every patient namely after anesthetic induction (baseline), during left internal mammary artery (LIMA) to left anterior descending (LAD) grafting (LIMA → LAD), saphenous vein graft (SVG) to obtuse marginal (OM) grafting (SVG → OM), SVG to posterior descending artery (PDA) grafting (SVG → PDA), during proximal anastomosis of SVG to aorta, and postprotamine. The patients were classified in grades of LVDD as per simplified algorithm proposed by Swaminathan et al. using only intraoperatively measured E and E’. Results: The success rate of measurement and classification of LVDD was 98.92% (277 out of 280 measurements). The grades of LVDD varied significantly as per surgical steps with maximum downgrading occurring during OM and LAD grafting. During OM grafting, none of the patients had normal diastolic function while 29% of patients exhibited restrictive pattern (Grade 3 LVDD). Patients with normal baseline LV diastolic function also exhibited downgrading during OM and LAD grafting. Postprotamine, 37% of patients with normal baseline diastolic function continued to exhibit some degree of DD. Conclusions: The LVDD changes dynamically during various stages of OPCABG, which can be successfully monitored with simplified algorithm.
Collapse
Affiliation(s)
- Deepak Prakash Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, United CIIGMA Hospital, Aurangabad, Maharashtra, India
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
McIlroy DR, Lin E, Hastings S, Durkin C. Intraoperative Transesophageal Echocardiography for the Evaluation and Management of Diastolic Dysfunction in Patients Undergoing Cardiac Surgery: A Survey of Current Practice. J Cardiothorac Vasc Anesth 2016; 30:389-97. [DOI: 10.1053/j.jvca.2015.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Indexed: 11/11/2022]
|
11
|
McIlroy DR, Lin E, Durkin C. Intraoperative Transesophageal Echocardiography: A Critical Appraisal of Its Current Role in the Assessment of Diastolic Dysfunction. J Cardiothorac Vasc Anesth 2015; 29:1033-43. [DOI: 10.1053/j.jvca.2015.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Indexed: 12/26/2022]
|
12
|
Shim JK, Song JW, Song Y, Kim JH, Kang HM, Kwak YL. Pulse pressure variation is not a valid predictor of fluid responsiveness in patients with elevated left ventricular filling pressure. J Crit Care 2014; 29:987-91. [PMID: 25216949 DOI: 10.1016/j.jcrc.2014.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/02/2014] [Accepted: 07/03/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to test the hypothesis that the predictive ability of pulse pressure variation (PPV) for fluid responsiveness would be altered in patients with elevated left ventricular (LV) filling pressure. MATERIALS AND METHODS According to the preoperative echocardiographic assessment of the ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/E'), patients undergoing surgical coronary revascularization were classified into normal (n=34, E/E'<8) and high (n=34, E/E'>15) LV filling pressure group. After anesthetic induction, PPV and hemodynamic data were measured before and after 6 mL/kg of colloid administration. Fluid responsiveness was defined as 12% or more increase in stroke volume index assessed by pulmonary artery catheter and tested by the area under the receiver operating characteristic curve (AUROC). RESULTS The AUROCs of PPV in the normal and high filling pressure group were 0.829 (95% confidence interval [CI], 0.661-0.963; P<.001) and 0.583 (95% CI, 0.402-0.749; P=.110), respectively. The AUROCs of cardiac filling pressures and right ventricular end-diastolic volume index did not show statistical significance in both groups. CONCLUSIONS None of the assessed preload indices including PPV were able to predict fluid responsiveness in patients with elevated LV filling pressure.
Collapse
Affiliation(s)
- Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University Health System, Seoul, 120-752, South Korea; Anesthesia and Pain Research Institute, Yonsei University Health System, Seoul, 120-752, South Korea
| | - Jong-Wook Song
- Department of Anesthesiology and Pain Medicine, Yonsei University Health System, Seoul, 120-752, South Korea; Anesthesia and Pain Research Institute, Yonsei University Health System, Seoul, 120-752, South Korea
| | - Young Song
- Department of Anesthesiology and Pain Medicine, Yonsei University Health System, Seoul, 120-752, South Korea; Anesthesia and Pain Research Institute, Yonsei University Health System, Seoul, 120-752, South Korea
| | - Ji-Ho Kim
- Department of Anesthesiology and Pain Medicine, National Health Insurance Service Ilsan Hospital, Goyang City, Gyeonggi-do, 410-719, South Korea
| | - Hye-Min Kang
- Department of Anesthesiology and Pain Medicine, Yonsei University Health System, Seoul, 120-752, South Korea
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine, Yonsei University Health System, Seoul, 120-752, South Korea; Anesthesia and Pain Research Institute, Yonsei University Health System, Seoul, 120-752, South Korea.
| |
Collapse
|
13
|
Song Y, Shim JK, Song JW, Shim CY, Kim EK, Kwak YL. Association of Carotid Arterial Circumferential Strain With Left Ventricular Function and Hemodynamic Compromise During Off-Pump Coronary Artery Bypass Surgery. Circ J 2014; 78:2422-30. [DOI: 10.1253/circj.cj-14-0378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Young Song
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine
| | - Jong-Wook Song
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine
| | - Chi-Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Eui-Kyung Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine
| |
Collapse
|
14
|
Suehiro K, Tanaka K, Matsuura T, Funao T, Yamada T, Mori T, Nishikawa K. Detection of left ventricular dysfunction using early diastolic mitral annular velocity in patients undergoing mitral valve repair for mitral regurgitation. J Cardiothorac Vasc Anesth 2013; 28:25-30. [PMID: 24183315 DOI: 10.1053/j.jvca.2013.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Ejection fraction (EF) is considered an unreliable index in patients with mitral regurgitation (MR). Left ventricular dysfunction (LVD) frequently occurs after mitral valve repair (MVR), with the incidence being 15% to 34%. This study aimed at investigating whether preoperative early diastolic mitral annular velocity (E') is associated with LVD after MVR. DESIGN Retrospective study. SETTING University hospital. PARTICIPANTS Sixty-three patients undergoing MVR for severe MR. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS LVD was defined by a postoperative EF of<50%. Receiver operating characteristic (ROC) analysis and separate multivariate logistic regression models were used to examine the independent effects of echocardiographic variables on LVD risk. LVD occurred in 20 patients (31.7%). E' was correlated significantly with perioperative EF change (p = 0.019, r = 0.293). The area under the ROC curve was 0.777 (95% confidence interval [CI]: 0.644-0.911) for E', and the optimal threshold value of E' for predicting LVD was 6.5 cm/s (sensitivity, 80%; specificity, 67.4%). The frequency of LVD was 33.3% for a preoperative EF< 65%; 44.4% for preoperative EF< 65% and left ventricular end-systolic diameter>32 mm; and 88.9% for preoperative EF< 65%, left ventricular end-systolic diameter>32 mm, and E'< 6.5 cm/s (p = 0.006). Multivariate logistic regression models analysis revealed that E' was an independent risk factor for LVD (odds ratio: 1.98, 95% CI: 1.22-3.22). CONCLUSIONS Preoperative E' value was an independent risk factor of LVD after mitral valve repair in patients with severe MR.
Collapse
Affiliation(s)
- Koichi Suehiro
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Katsuaki Tanaka
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Matsuura
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomoharu Funao
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tokuhiro Yamada
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takashi Mori
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kiyonobu Nishikawa
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
15
|
Kumar K, Jassal DS. Reply: To PMID 23190400. Echocardiography 2013; 30:365. [PMID: 23452143 DOI: 10.1111/echo.12152_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
16
|
Demirkol S, Balta S, Cakar M, Unlu M, Arslan Z. The role of tissue Doppler imaging in predicting left ventricular filling pressures in patients undergoing cardiac surgery: an intraoperative study: can we use transesophageal echocardiography in predicting the left ventricular filling pressures? Echocardiography 2013; 30:364. [PMID: 23452142 DOI: 10.1111/echo.12152_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
17
|
Akiyama K, Arisawa S, Ide M, Iwaya M, Naito Y. Intraoperative cardiac assessment with transesophageal echocardiography for decision-making in cardiac anesthesia. Gen Thorac Cardiovasc Surg 2013; 61:320-9. [PMID: 23404310 DOI: 10.1007/s11748-013-0208-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Indexed: 11/25/2022]
Abstract
Transesophageal echocardiography is an invaluable hemodynamic monitoring modality. Extended and anatomically based evaluation of cardiac function with transesophageal echocardiography is essential to prompt and accurate decision-making in anesthetic management during cardiac surgery. Fractional shortening and fractional area changes are indices widely used to assess the global systolic performance of the left ventricle. Monitoring regional function using semi-quantitative scoring has been demonstrated to be a more sensitive indicator of myocardial ischemia. Assessment of left ventricular diastolic function should be performed in a systematic way, measuring transmitral flow, pulmonary venous flow, transmitral color M-mode flow propagation velocity, and mitral annulus tissue Doppler imaging. The unique anatomical features of the right ventricle make echocardiographic evaluation complicated and therefore less frequently employed. Right ventricular fractional area change, tricuspid annular plane systolic excursion, maximal systolic tricuspid annular velocity with tissue Doppler imaging, and myocardial performance index are indices successfully incorporated into intraoperative right ventricular assessment. Left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve may develop after cardiac procedures. Transesophageal echocardiography plays a central role in prevention as well as diagnosis of systolic anterior motion. Transesophageal echocardiography is extremely useful not only for detecting and locating intracardiac air, but also for guiding and evaluating the procedures to remove air. Air is likely to persist in the right and left superior pulmonary vein, left ventricular apex, left atrium, right coronary sinus of Valsalva, and ascending aorta. Accurate evaluation of cardiac function depends on performing TEE examination properly and obtaining optimal images.
Collapse
Affiliation(s)
- Koichi Akiyama
- Department of Anesthesia, Akashi Medical Center, 743-33 Okubo-cho Yagi, Akashi, 674-0063, Japan
| | | | | | | | | |
Collapse
|
18
|
Current world literature. Curr Opin Cardiol 2012; 27:682-95. [PMID: 23075824 DOI: 10.1097/hco.0b013e32835a0ad8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
|