Prognostic value of a tissue Doppler-derived index of left ventricular filling pressure on composite morbidity after off-pump coronary artery bypass surgery

• Published in: British journal of anaesthesia : BJA Vol. 107; no. 4; pp. 519 - 524
• Main Authors: Jun, N.H., Shim, J.K., Kim, J.C., Kwak, Y.L.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-10-2011; Oxford University Press
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arrhythmias, Cardiac - physiopathology; Biological and medical sciences; Coronary Artery Bypass, Off-Pump - adverse effects; Coronary Artery Bypass, Off-Pump - mortality; diastolic dysfunction; E/e′ value; Echocardiography, Doppler, Pulsed - methods; Endpoint Determination; Female; Humans; Length of Stay; Logistic Models; LV filling pressure; Male; Medical sciences; Middle Aged; Mitral Valve - physiology; off-pump coronary artery bypass; Perioperative Care; Postoperative Complications - epidemiology; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Factors; Ventricular Function, Left - physiology; diastolic dysfunction; E/e′ value; off-pump coronary artery bypass; LV filling pressure; value; /; E/e' value; Prognosis; Surgery; Cardiovascular disease; Anesthesia; Coronary heart disease; Morbidity; Left ventricle
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aer188

The ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e′) is an indicator of diastolic function that correlates well with left ventricular (LV) filling pressure and is relatively independent of systolic function and rhythm abnormalities. We prospectively evaluated the predictive value of E/e′ for postoperative outcome in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB).
Patients undergoing OPCAB were classified into three groups according to their E/e′ ratio: (i) normal E/e′ <8; (ii) undetermined E/e′ ≥8 and ≤15; and (iii) elevated E/e′ >15. Among those with E/e′ between 8 and 15, patients with elevated LV filling pressure were further identified by comprehensive Doppler examination. These patients were classified as having a high LV filling pressure, together with patients who had E/e′ ratios >15. Univariate and multivariate regression analyses were used to evaluate the relationship between preoperative variables and composite endpoints for morbidity.
In univariate analysis, diabetes mellitus, recent myocardial infarction, chronic obstructive pulmonary disease, serum creatinine (sCr) concentration, E/e′ >15, high LV filling pressure, LV ejection fraction, New York Heart Association class III and IV, and use of diuretics were significant risk factors for postoperative morbidity. In multivariate regression analysis of these variables, only sCr (odds ratio 1.4) and E/e′ >15 (odds ratio 2.4) or high LV filling pressure (odds ratio 2.8) remained as independent risk factors.
E/e′ ratio >15 was a significant predictor of composite endpoints of postoperative morbidity. We suggest that E/e′ ratio should be included in the routine preoperative assessment of patients presenting for OPCAB.