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CARDIOVASCULAR ANESTHESIA

The Effects of Load on Systolic Mitral Annular Velocity by Tissue Doppler Imaging

Ruggero Amà, MD^*, Patrick Segers, PhD^*, Carl Roosens, MD, Tom Claessens^*, Pascal Verdonck, PhD^*, and Jan Poelaert, MD PhD

*Hydraulics Laboratory, Institute Biomedical Technology; and Department of Intensive Care Unit, Ghent University Hospital and International Research Center, Ghent University, Belgium

Address correspondence and reprint requests to J Poelaert, MD, PhD, Department of Intensive Care Unit, 5K12 IE, Ghent University Hospital, De Pintelaan 185, B9000 Gent, Belgium. Address e-mail to jan.poelaert{at}rug.ac.be

Tissue Doppler Imaging (TDI) provides information on systolic function through its systolic mitral annulus velocity wave (Sm), reflecting the peak velocity of shortening of the myocardial fibers oriented in the longitudinal direction. In this study, we evaluated the effect of load changes on Sm. Forty-two cardiac surgical patients with left ventricular ejection fraction >60% were consecutively evaluated. In 24 patients, load was changed with an IV bolus of phenylephrine (50–100 µg) or nitroglycerine (300–500 µg); in 18 patients, preload was changed with a rapid infusion of 500 mL of a gelatin solution. The sample volume of TDI was placed at the lateral side of the mitral annulus in the mid-esophageal 4-chamber view. Changing loading conditions with phenylephrine or nitroglycerine had no effect on Sm; the increase of preload in 18 patients resulted in a statistically significant increase of Sm (baseline, 8.4 ± 2.6 cm/s; after increase of preload, 9.6 ± 2.5 cm/s; P = 0.001). We conclude that Sm is dependent on changes in preload obtained by volume loading and cannot be recommended as an index of ventricular contractile performance in critically ill patients where significant changes in ventricular filling occur.

IMPLICATIONS: We evaluated the effects of load changes on systolic mitral annular velocity (Sm) by Tissue Doppler Imaging velocity. Our results show that Sm is dependent on increases in preload and cannot be recommended as a variable of ventricular contractile performance in critically ill patients where significant changes in ventricular filling occur.

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