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CARDIOVASCULAR ANESTHESIA

The Effect of Pericardial Restraint, Atrial Pacing, and Increased Heart Rate on Left Ventricular Systolic and Diastolic Function in Patients Undergoing Cardiac Surgery

Colin F. Royse, MBBS MD, FANZCA^*,, Alistair G. Royse, MBBS MD, FRACS^*,, Christina T. Wong^*, and Paul F. Soeding, MBBS FANZCA

*Department of Pharmacology, University of Melbourne; and Departments of Anaesthesia and Pain Management and Cardiothoracic Surgery, The Royal Melbourne Hospital, Australia

Address correspondence and reprint requests to Colin Royse, MD, PO Box 1022, Research, Victoria, Australia, 3095. Address e-mail to Colin.Royse{at}mh.org.au

Baseline measurements of systolic and diastolic function performed after the induction of anesthesia may be compared with subsequent measurements acquired under different physical conditions such as open pericardium and different heart rate or rhythm. We acquired data from 21 patients undergoing coronary artery surgery. Combined echocardiographic and pulmonary artery catheter measurements were performed before and after pericardial opening, atrial pacing at the native rate, and atrial pacing 30 bpm faster. Indices of systolic function included fractional area change, afterload corrected fractional area change, and myocardial performance index; diastolic function included mitral inflow and pulmonary vein Doppler profiles, color M-Mode Doppler flow propagation velocity, instantaneous end-diastolic stiffness, and isovolumetric relaxation time. Hemodynamic indices included cardiac index, mean arterial, right atrial, and pulmonary capillary wedge pressures, and systemic vascular resistance index. There were no changes in measurements after opening of the pericardium or with institution of atrial pacing. With increased heart rate, there were no changes in systolic function, but instantaneous end-diastolic stiffness increased. Propagation velocity showed a paradoxical improvement with increased heart rate opposite to other trends. Beat fusion occurs with increasing heart rate for mitral inflow Doppler. We recommend that serial measurements are performed at a similar heart rate.

IMPLICATIONS: Pericardial restraint or the institution of atrial pacing do not alter left ventricular function, as assessed by pulmonary artery catheter and transesophageal echocardiography measurements. Diastolic (but not systolic) measurements showed inconsistency with increased heart rate.

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