Association Between Elevated Echocardiographic Index of Left Ventricular Filling Pressure and Acute Kidney Injury After Off-Pump Coronary Artery Surgery

Abstract

and mortality. 4,9 Hemodynamic disturbance during OPCAB has been reported to have a biventricular contribution, and the major cause is believed to be diastolic dysfunction and abnormal filling of both ventricles. 10,11 As such, it is possible that an underlying increased LVFP may aggravate the intraoperative hemodynamic disturbance, resulting in a higher rate of postoperative AKI. Although previous studies have reported the effect of diastolic dysfunction on postoperative outcomes, including death or major adverse cardiac events (MACE), 4,12 postoperative renal dysfunction was evaluated only as a secondary outcome and the association between increased LVFP in patients with normal LV systolic function and postoperative AKI has not been fully evaluated.The ratio of the early transmitral blood flow velocity to early diastolic velocity of the mitral annulus (E/e′) has been reported to have good predictive power for mean LV diastolic pressure or mean LVFP and has been used to estimate the diastolic function of the heart. 13,14 E/e′ >15 is P erioperative acute kidney injury (AKI) has been reported to be an important contributor to postoperative morbidity and mortality especially after cardiovascular surgery, including coronary artery bypass graft (CABG). 1,2 Off-pump coronary artery bypass surgery (OPCAB) has been associated with less severe and a lower incidence of AKI compared with on-pump CABG. 3 Nonetheless, there is still a substantial incidence of AKI after OPCAB and it is caused by transient circulatory arrest, global hypoperfusion, myocardial ischemia-reperfusion injury, and inflammatory response. 3 The incidence of diastolic dysfunction in patients who undergo CABG has been reported as high. 4,5 Although many studies have reported systolic dysfunction of the heart as a risk factor for postoperative AKI, 6,7 the association between preoperative diastolic dysfunction and postoperative AKI has not been investigated. A stiff left ventricle with low compliance would lead to an elevated LV filling pressure (LVFP), 8 which is associated with higher morbidity Background: The ratio of the early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e′) is an echocardiographic index of mean left ventricular (LV) filling pressure. We investigated the association between the preoperative E/e′ ratio and postoperative acute kidney injury (AKI) during off-pump coronary artery bypass surgery (OPCAB).

Perioperative Echocardiographic Index of Left Ventricular Filling Pressure in Cardiac Surgery

“…In our study, the incidence of AKI was significantly higher in patients with an elevated postoperative E/e 0 after matching. A previous study showed similar results in patients who underwent off-pump coronary artery bypass with preserved preoperative LVEF [4]. The association between the elevated LVFP and postoperative AKI can be explained by the following mechanisms.…”

“…Previous studies indicated the prognostic value of the preoperative E/e 0 ratio. The preoperative E/e 0 ratio was associated with postoperative complications, including AKI and major adverse cardiac events [1,2,4,21]. A composite of in-hospital cardiovascular complications, including embolic infarct, cardiopulmonary resuscitation, and requirement for cardioversion or pacemaker implantation, develops more frequently in patients with a preoperative E/e 0 ratio >12 than in those with an E/e 0 ratio 12 after isolated aortic valve replacement [2].…”

“…Previous studies indicated that noninvasive echocardiographic measurement of elevated LVFP was associated with higher morbidity and mortality [1][2][3]. Furthermore, a previous retrospective study showed that an elevated echocardiographic index of LVFP; that is, the ratio of early transmitral blood flow velocity to the early diastolic velocity of the mitral annulus (E/e 0 ), was significantly associated with the increased risk of postoperative acute kidney injury (AKI) [4].…”

Derivation and Validation of Machine Learning Approaches to Predict Acute Kidney Injury after Cardiac Surgery

“…On the basis of previous studies, data related to demographic or perioperative variables known to be related to postoperative renal dysfunction were collected ( Table 1 ) [ 6 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 19 , 20 , 21 , 22 , 23 ]. The following perioperative clinical variables were collected: patient demographics, medical history, medication history, baseline laboratory finding, surgery type, operation time, type of anesthesia, intraoperative fluid and colloid administration, intraoperative transfusion amount, and intraoperative hemodynamic variables.…”

Diastolic dysfunction and acute kidney injury in elderly patients with femoral neck fracture

“…The result is an increase in renal venous and intra-abdominal pressure, which worsens renal function [30,31]. A higher E/e’ ratio is an independent predictor of AKI occurring after cardiac surgery [32,33]. An E/e’ ratio > 15 is associated with AKI among patients with ST-segment elevation myocardial infarction [34].…”