Journal of cardiothoracic and vascular anesthesia · 2018
Intraoperative assessment of left-ventricular diastolic function by two-dimensional speckle tracking echocardiography: relationship between pulmonary capillary wedge pressure and peak longitudinal strain rate during isovolumetric relaxation in patients undergoing coronary artery bypass graft surgery.
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Ebrahimi Farzad, Kohanchi David, Gharedaghi Mohammad Hadi, Petrossian Vaheh
Аннотация
OBJECTIVES: Two-dimensional speckle tracking echocardiography has advantages over tissue Doppler imaging during isovolumetric relaxation for predicting left-ventricular end-diastolic pressure in non-surgical patients. Considering the direct and indirect effects of general anesthesia on hemodynamics, we examined correlations between strain-based indices during isovolumetric relaxation and pulmonary capillary wedge pressure in anesthetized patients. Moreover, we determined applicable cut-off values for strain-based indices to predict pulmonary capillary wedge pressure ≥15 mmHg intraoperatively.
DESIGN: Retrospective clinical study.
SETTING: Single university hospital.
PARTICIPANTS: Thirty adult patients with preserved ejection fraction undergoing coronary artery bypass grafting.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Two-dimensional speckle tracking echocardiography was used to measure strain rate during isovolumetric relaxation (SRIVR) and to calculate the mitral early diastolic inflow (E) to SRIVR ratio (E/SRIVR). Tissue Doppler imaging was used to calculate the E to early diastolic velocity at the lateral mitral annulus ratio (lateral E/e'). SRIVR and E/SRIVR showed strong correlations with pulmonary capillary wedge pressure (r = 0.80 and 0.73, respectively; p < 0.001 and p < 0.001). Lateral E/e' correlated with pulmonary capillary wedge pressure (r = 0.42; p < 0.05). SRIVR predicted high pulmonary capillary wedge pressure better than lateral E/e' did (areas under the receiver operating characteristic curves, 0.94-vs. 0.47, respectively). SRIVR <0.2 s-1 had a sensitivity of 100% and a specificity of 81% for predicting pulmonary capillary wedge pressure ≥15 mmHg.
CONCLUSIONS: SRIVR is superior to tissue Doppler indices for predicting pulmonary capillary wedge pressure intraoperatively in patients with coronary artery disease and preserved ejection fraction.
DESIGN: Retrospective clinical study.
SETTING: Single university hospital.
PARTICIPANTS: Thirty adult patients with preserved ejection fraction undergoing coronary artery bypass grafting.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Two-dimensional speckle tracking echocardiography was used to measure strain rate during isovolumetric relaxation (SRIVR) and to calculate the mitral early diastolic inflow (E) to SRIVR ratio (E/SRIVR). Tissue Doppler imaging was used to calculate the E to early diastolic velocity at the lateral mitral annulus ratio (lateral E/e'). SRIVR and E/SRIVR showed strong correlations with pulmonary capillary wedge pressure (r = 0.80 and 0.73, respectively; p < 0.001 and p < 0.001). Lateral E/e' correlated with pulmonary capillary wedge pressure (r = 0.42; p < 0.05). SRIVR predicted high pulmonary capillary wedge pressure better than lateral E/e' did (areas under the receiver operating characteristic curves, 0.94-vs. 0.47, respectively). SRIVR <0.2 s-1 had a sensitivity of 100% and a specificity of 81% for predicting pulmonary capillary wedge pressure ≥15 mmHg.
CONCLUSIONS: SRIVR is superior to tissue Doppler indices for predicting pulmonary capillary wedge pressure intraoperatively in patients with coronary artery disease and preserved ejection fraction.