Tissue Doppler Em and Instantaneous End-diastolic Stiffness: Validation Against Pressure–Volume Loops in Patients Undergoing Coronary Artery Bypass Surgery

Connelly, Kim A.; Royse, Colin; Royse, Alistair

doi:10.1016/j.hlc.2011.01.003

Cited by 6 publications

(3 citation statements)

References 28 publications

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“…While tissue Doppler imaging of the left ventricle is supposed to be more independent of preload than flow Doppler 27–29 , acute preload changes can impact also on tissue Doppler measurements 30 . In this study fluid status was not assessed directly.…”

Section: Discussionmentioning

confidence: 99%

Impaired Systolic and Diastolic Left Ventricular Function in Children with Chronic Kidney Disease - Results from the 4C Study

Doyon

Haas

Erdem

et al. 2019

Sci Rep

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Children with chronic kidney disease suffer from excessive cardiovascular mortality and early alterations of the cardiovascular system. Tissue doppler imaging is a validated echocardiographic tool to assess early systolic and diastolic cardiac dysfunction. We hypothesized that tissue Doppler velocities would reveal reduced cardiac function in children with chronic kidney disease compared to healthy children. A standardized echocardiographic exam was performed in 128 patients of the Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) Study aged 6–17 years with an estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m 2 . Tissue Doppler measurements included early (E’) and late (A’) diastolic and systolic (S’) velocity at the mitral and septal annulus of the left ventricle. Measured values were normalized to z-scores using published reference data. Predictors of E’/A’, E/E’, S’ and left ventricular mass index (LVMI) were assessed by multiple linear regression analyses. Tissue Doppler E’ was reduced and tissue Doppler A’ increased, resulting in a reduced tissue Doppler E’/A’ ratio (z-score −0.14, p < 0.0001) indicating reduced diastolic function compared to healthy children. Reduced tissue Doppler E’/A’ Z-Scores were independently associated with lower eGFR (p = 0.002) and increased systolic blood pressure (p = 0.02). While E/E’ Z-Scores were increased (Z-score 0.57, p < 0.0001), patients treated with pharmacological RAS blockade but not with other antihypertensive treatments had significantly lower E/E’ and higher E’/A’ Z-Scores. Systolic tissue Doppler velocities were significantly decreased (Z-score −0.24, p = 0.001) and inversely correlated with E/E’ Z-Scores (r = −0.41, p < 0.0001). LVMI was not associated with systolic or diastolic tissue Doppler velocities. Concentric left ventricular hypertrophy showed a tendency to lower S’ in multivariate analysis (p = 0.13) but no association to diastolic function. Concentric left ventricular geometry was significantly associated with lower midwall fractional shortening. In summary, systolic and diastolic function assessed by tissue Doppler is impaired. eGFR, systolic blood pressure and the type of antihypertensive medications are significant predictors of diastolic function in children with CKD. Left ventricular morphology is largely independent of tissue Doppler velocities. Tissue Doppler velocities provide sensitive information about early left ventricular dysfunction in this population.

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Section: Discussionmentioning

confidence: 99%

Impaired Systolic and Diastolic Left Ventricular Function in Children with Chronic Kidney Disease - Results from the 4C Study

Doyon

Haas

Erdem

et al. 2019

Sci Rep

View full text Add to dashboard Cite

show abstract

“…These two datasets therefore allow ‘proof of concept’ analysis for PCWP estimation during stable as well as rapidly changing haemodynamic conditions. Details of these two cohorts of patients, including anaesthesia management and surgical information, have been previously published [24–28].…”

Section: Methodsmentioning

confidence: 99%

“…Patients were not studied if they were in atrial fibrillation, had aortic or mitral valve lesions classified as being greater than mild, or if transoesophageal echocardiography was contra‐indicated. The haemodynamic changes, individual echocardiography measurements, and inter‐observer agreement have also previously been published [27, 28]. For this retrospective study, the purpose was not to identify what happened at each loading intervention, but rather to investigate a wide range of haemodynamic and PCWP conditions.…”

Section: Methodsmentioning

confidence: 99%

The accuracy of transoesophageal echocardiography in estimating pulmonary capillary wedge pressure in anaesthetised patients

et al. 2011

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SummaryThe objective of this study was to identify whether pulmonary capillary wedge pressure can be estimated in anaesthetised patients receiving mechanical ventilation, using transoesophageal echocardiography. A retrospective validation study investigated a 10-patient cohort with variable haemodynamic conditions, and a 102-patient series in which a single measurement was made during stable haemodynamic conditions. Concurrent echocardiographic Doppler and pulmonary artery catheter wedge pressure measurements were performed. In the 10-patient cohort, the systolic fraction of Doppler measurements in the pulmonary vein (r = )0.32, p = 0.035) and the E ⁄ A ratio (r = 0.56, p = 0.0009) were correlated with the wedge pressure. In all cases, the limits of agreement exceeded 10 mmHg, and sensitivity or specificity for detecting wedge pressure ‡ 15 mmHg was poor. This study demonstrates proof of concept that using transoesophageal echocardiography for estimating the pulmonary artery wedge pressure may not be sufficiently accurate for clinical use.

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Perioperative Betreuung von Patienten mit diastolischer Herzinsuffizienz

et al. 2014

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Diastolic heart failure leads to an increase in perioperative morbidity and mortality. The prevalence of this disease is rising and multiple risk factors have already been identified. Besides higher age and female gender, arterial hypertension, diabetes mellitus and coronary artery disease in particular have to be considered. Clinical examination and laboratory analyses are important for preoperative evaluation; however, echocardiography plays the most important role in the diagnostics of diastolic heart failure. The transmitral flow profile can be used to differentiate the grades of diastolic dysfunction using the ratio between early passive ventricular filling (E) and late active filling due to atrial contraction (A). Data concerning the ideal anesthesia technique are for the most part lacking; however, the application of thoracic epidural anesthesia seems to be beneficial. A great deal of attention has to be paid to the intraoperative volume status of patients with diastolic dysfunction as hypovolemia and hypervolemia can both have detrimental effects. Arrhythmias and major changes in blood pressure put this special group of patients at additional risks.

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Tissue Doppler Em and Instantaneous End-diastolic Stiffness: Validation Against Pressure–Volume Loops in Patients Undergoing Coronary Artery Bypass Surgery

Cited by 6 publications

References 28 publications

Impaired Systolic and Diastolic Left Ventricular Function in Children with Chronic Kidney Disease - Results from the 4C Study

Impaired Systolic and Diastolic Left Ventricular Function in Children with Chronic Kidney Disease - Results from the 4C Study

The accuracy of transoesophageal echocardiography in estimating pulmonary capillary wedge pressure in anaesthetised patients

Perioperative Betreuung von Patienten mit diastolischer Herzinsuffizienz

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