Preoperative diastolic function predicts the onset of left ventricular dysfunction following aortic valve replacement in high-risk patients with aortic stenosisReportar como inadecuado

Preoperative diastolic function predicts the onset of left ventricular dysfunction following aortic valve replacement in high-risk patients with aortic stenosis - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Critical Care

, 14:R101

First Online: 03 June 2010Received: 01 September 2009Revised: 20 November 2009Accepted: 03 June 2010


IntroductionLeft ventricular LV dysfunction frequently occurs after cardiac surgery, requiring inotropic treatment and-or mechanical circulatory support. In this study, we aimed to identify clinical, surgical and echocardiographic factors that are associated with LV dysfunction during weaning from cardiopulmonary bypass CPB in high-risk patients undergoing valve replacement for aortic stenosis.

MethodsPerioperative data were prospectively collected in 108 surgical candidates with an expected operative mortality ≥9%. All anesthetic and surgical techniques were standardized. Reduced LV systolic function was defined by an ejection fraction <40%. Diastolic function of the LV was assessed using standard Doppler-derived parameters, tissue Doppler Imaging TDI and transmitral flow propagation velocity Vp.

ResultsDoppler-derived pulmonary flow indices and TDI could not be obtained in 14 patients. In the remaining 94 patients, poor systolic LV was documented in 14% n = 12 and diastolic dysfunction in 84% of patients n = 89, all of whom had Vp <50 cm-s. During weaning from CPB, 38 patients 40% required inotropic and-or mechanical circulatory support. By multivariate regression analysis, we identified three independent predictors of LV systolic dysfunction: age Odds ratio OR = 1.11; 95% confidence interval CI, 1.01 to 1.22, aortic clamping time OR = 1.04; 95% CI, 1.00 to 1.08 and Vp OR = 0.65; 95% CI, 0.52 to 0.81. Among echocardiographic measurements, Vp was found to be superior in terms of prognostic value and reliability. The best cut-off value for Vp to predict LV dysfunction was 40 cm-s sensitivity of 72% and specificity 94%. Patients who experienced LV dysfunction presented higher in-hospital mortality 18.4% vs. 3.6% in patients without LV dysfunction, P = 0.044 and an increased incidence of serious cardiac events 81.6 vs. 28.6%, P < 0.001.

ConclusionsThis study provides the first evidence that, besides advanced age and prolonged myocardial ischemic time, LV diastolic dysfunction characterized by Vp ≤ 40 cm-sec identifies patients who will require cardiovascular support following valve replacement for aortic stenosis.

AbbreviationsBNPbrain natriuretic peptides

CIconfidence interval

CPBcardiopulmonary bypass

DTdeceleration time

E- and A-early and late diastolic velocities of the mitral annulus

EDAend-diastolic area

ESAend-systolic area

FACfractional area change

IABPintra-aortic balloon pump

IVRTisovolumic relaxation time

LVleft ventricular

MAPmean arterial pressure

ORsodds ratios

PWTposterior wall thickness


SD and Ar: peak systolic, diastolic and atrial reversal velocities of pulmonary venous flow

TDItissue Doppler imaging

TEEtransoesophageal echocardiography

Vptransmitral flow propagation velocity.

Electronic supplementary materialThe online version of this article doi:10.1186-cc9040 contains supplementary material, which is available to authorized users.

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Autor: Marc Licker - Mustafa Cikirikcioglu - Cidgem Inan - Vanessa Cartier - Afksendyios Kalangos - Thomas Theologou - Tiziano Cas


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