Assessment of length-dependent regulation of myocardial function in coronary surgery patients using transmitral flow velocity patterns
| Autor: | H. F. Adriaensen, Pieter W. ten Broecke, Peter A. De Mulder, Inez Rodrigus, Philippe J. Van der Linden, Stefan De Hert |
|---|---|
| Přispěvatelé: | Other departments |
| Rok vydání: | 2000 |
| Předmět: |
Male
medicine.medical_specialty Muscle Relaxation Posture Diastole Hemodynamics Coronary surgery Ventricular Function Left Experimental diagnostics and therapy of malignancies Mitral valve Internal medicine Linear regression medicine Humans Coronary Artery Bypass business.industry Blood flow Middle Aged Myocardial Contraction Echocardiography Doppler Dipyridamole Anesthesiology and Pain Medicine medicine.anatomical_structure Flow velocity Linear Models Cardiology Mitral Valve Female business Blood Flow Velocity Echocardiography Transesophageal medicine.drug |
| Zdroj: | Anesthesiology, 93, 374-381 Anesthesiology, 93(2), 374-381. Lippincott Williams and Wilkins Anesthesiology, 93, 2, pp. 374-381 Anesthesiology |
| ISSN: | 0003-3022 |
| Popis: | Background In a subset of coronary surgery patients, a transient increase in cardiac load by leg elevation resulted in a decrease in maximal rate of pressure development (dP/dtmax) and a major increase in end-diastolic pressure (EDP). This impairment of left ventricular (LV) function appeared to be related to a deficient length-dependent regulation of myocardial function. The present study investigated whether analysis of transmitral flow patterns with transesophageal echocardiography constituted a noninvasive method to identify these patients. Methods High-fidelity LV pressure tracings and transmitral flow signals were obtained in 50 coronary surgery patients during an increase in cardiac load by leg elevation. Using linear regression analysis, changes in transmitral E-wave velocity and deceleration time (DT) were related to changes in dP/dtmax and EDP. Results Changes in dP/dtmax with leg elevation were closely related to corresponding changes in E-wave velocity (r = 0.81; P < 0. 001) and to changes in DT (r = 0.78; P < 0.001). Similarly, changes in EDP were related to changes in E-wave velocity (r = 0.83; P < 0. 001) and to changes in DT (r = 0.84; P < 0.001). The decrease in dP/dtmax and the major increase in EDP in some patients was associated with an increase in E-wave velocity and a decrease in DT, indicating development of a restrictive LV filling pattern. Conclusions Impairment of LV function with leg elevation was associated with the development of a restrictive transmitral filling pattern. Analysis of transmitral flow patterns by means of transesophageal echocardiography therefore allowed noninvasive identification of a subset of coronary surgery patients with impaired length-dependent regulation of LV function. |
| Databáze: | OpenAIRE |
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