JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (7) Citing Articles via Google Scholar Google Scholar Articles by Lattik, R. Articles by Tardif, J.-C. Search for Related Content PubMed PubMed Citation Articles by Lattik, R. Articles by Tardif, J.-C.

---

CARDIOVASCULAR ANESTHESIA

Mitral Doppler Indices Are Superior to Two-Dimensional Echocardiographic and Hemodynamic Variables in Predicting Responsiveness of Cardiac Output to a Rapid Intravenous Infusion of Colloid

Robert Lattik, MD^*, Pierre Couture, MD^*, André Y. Denault, MD^*, Michel Carrier, MD, François Harel, MsC, Jean Taillefer, MD^*, and Jean-Claude Tardif, MD

Departments of *Anesthesiology, Cardiac Surgery, Biostatistics, and Medicine, Montreal Heart Institute, Montreal, Quebec, Canada

Address correspondence and reprint requests to Pierre Couture, MD, Department of Anesthesiology, Montreal Heart Institute, 5000 Belanger St. E., Montreal, Quebec, Canada, H1T 1C8. Address e-mail to p.couture{at}sympatico.ca

We hypothesized that mitral flow (MF) Doppler measurements could be used to predict cardiac output (CO) responsiveness to fluid challenge. Fourteen patients with normal systolic and diastolic function, scheduled for coronary artery bypass graft surgery, were evaluated as part of a pilot study in which preload was varied immediately before the beginning of cardiopulmonary bypass. A Validation group of 36 patients with different levels of systolic and diastolic function received a rapid infusion of 500 mL of 10% pentastarch. By use of transesophageal echocardiography, we measured left ventricular end-diastolic area, pulsed Doppler indices of the MF and pulmonary venous flow, and standard hemodynamic variables during acute volemic variations. A baseline measurement was first recorded, followed by measurements taken after a decrease (211 ± 87 mL) and then an increase (176 ± 149 mL) in preload (pilot study) and before and after 500 mL of pentastarch (validation study). In the pilot study, we found that a low velocity/time integral (VTI) E wave/A wave (E/A) ratio was associated with a larger increase in CO secondary to an increase in preload (r = 0.64, P < 0.05). Stepwise linear regression identified Doppler measurements of the mitral VTI E/A ratio as the most important variable to predict the increase in CO after fluid infusion. In the validation study, a mitral E/A ratio <1.26 before fluid infusion best predicted a 20% increase in stroke volume (receiver operating characteristic curve, 71%; P < 0.05), whereas no other hemodynamic or echocardiographic variable predicted preload responsiveness. We conclude that the MF Doppler filling pattern is an important factor to predict the increase in CO after intravascular fluid challenge in patients undergoing coronary artery bypass grafting.

IMPLICATIONS: In the presence of low cardiac output, the clinician’s ability to identify which patients are more likely to benefit from volume administration to improve hemodynamic status while avoiding fluid overload is important. The analysis of Doppler measurement of the mitral flow as an indirect indicator of the individual diastolic pressure/volume relationship may be useful to predict the intravascular volume responsiveness in patients undergoing coronary artery bypass graft surgery.

This article has been cited by other articles:

				H. Solus-Biguenet, M. Fleyfel, B. Tavernier, E. Kipnis, J. Onimus, E. Robin, G. Lebuffe, C. Decoene, F. R. Pruvot, and B. Vallet Non-invasive prediction of fluid responsiveness during major hepatic surgery Br. J. Anaesth., December 1, 2006; 97(6): 808 - 816. [Abstract] [Full Text] [PDF]

				A. Y. Denault, P. Couture, J. Buithieu, F. Haddad, M. Carrier, D. Babin, S. Levesque, and J.-C. Tardif Left and right ventricular diastolic dysfunction as predictors of difficult separation from cardiopulmonary bypass: [La dysfonction ventriculaire diastolique gauche et droite comme predicteur des difficultes de sevrage de la circulation extracorporelle]. Can J Anesth, October 1, 2006; 53(10): 1020 - 1029. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999