Perioperative Echocardiographic Index of Left Ventricular Filling Pressure in Cardiac Surgery

Abstract

Background. The elevated preoperative ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e 0 ) as an echocardiographic index of left ventricular filling pressure is known to be associated with poor postoperative outcomes. We investigated the association between preoperative and postoperative E/e 0 elevation and clinical outcomes after cardiac operations.Methods. The study divided 1,353 patients who underwent cardiac operations into four groups: preoperative and postoperative E/e 0 £15 (low-low), preoperative E/e 0 £15 but postoperative E/e 0 >15 (low-high), preoperative E/e 0 >15 but postoperative E/e 0 £15 (high-low), and preoperative and postoperative E/e 0 >15 (high-high). Cox proportional hazard analysis was performed. Kaplan-Meier curve analysis was performed before and after propensity score matching.Results. The four perioperative E/e 0 categories were independently associated with 5-year mortality (hazard ratio, high-high vs low-low: 3.58; low-high vs low-low: Patients and MethodsThis study was approved by the Seoul National University Institutional Review Board (IRB #1604-037-753). The

Peri‐operative changes in diastolic function and outcomes in congenital aortic valve surgery

“…[28][29][30] In those undergoing aortic valve replacement, both pre-and post-operative E/e' have been shown to be associated with post-operative morbidity, including heart failure and acute kidney injury (AKI), and mortality. 1,6,7 This study is the first, to our knowledge, in the pediatric literature to describe the changes in tissue Doppler measurements in the setting of congenital aortic valve surgery and to assess the association with early post-operative outcomes. Eidem et al previously showed that children with unrepaired AS have significantly increased medial and lateral E/e' ratios when compared to healthy controls.…”

“… 28 , 29 , 30 In those undergoing aortic valve replacement, both pre‐and post‐operative E/e’ have been shown to be associated with post‐operative morbidity, including heart failure and acute kidney injury (AKI), and mortality. 1 , 6 , 7 …”

“…5 Adult studies have described the changes in pre-and post-operative E/e' and shown associations between pre-and post-operative E/e' and post-operative clinical outcomes, including mortality, in those undergoing aortic valve replacement. 6,7 Children and young adults undergoing congenital aortic valve surgery have a range of post-operative clinical outcomes. 8,9 While E/e' and other tissue Doppler indices have been shown to correlate with LV filling pressures in pediatric patients, 10 the peri-operative changes in these measures have not been well-described.…”

“… 5 Adult studies have described the changes in pre‐ and post‐operative E/e’ and shown associations between pre‐and post‐operative E/e’ and post‐operative clinical outcomes, including mortality, in those undergoing aortic valve replacement. 6 , 7 …”

Quantitative Transthoracic Echocardiography of the Response to Dobutamine in Cardiac Surgery Patients With Low Cardiac Output Syndrome

“…8 The moderate association between postoperative E/e' values and LCOS in the present study is in agreement with the prognostic value described in larger cohorts. 42 The low observed value of LV longitudinal Doppler parameters may be explained by individual variability associated with sex and age in healthy populations 30 and surgical series. 43 Low increases in lactate concentration have been linked to greater mortality in critically ill patients.…”