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Prognostic value of a tissue Doppler-derived index of left ventricular filling pressure on composite morbidity after off-pump coronary artery bypass surgery

Authors
 전나형 ; 곽영란 ; 김종찬 ; 심재광 
Citation
 British Journal of Anaesthesia, Vol.107(4) : 519~524, 2011 
Journal Title
 British Journal of Anaesthesia 
ISSN
 0007-0912 
Issue Date
2011
Abstract
BACKGROUND: The ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e') is an indicator of diastolic function that correlates well with left ventricular (LV) filling pressure and is relatively independent of systolic function and rhythm abnormalities. We prospectively evaluated the predictive value of E/e' for postoperative outcome in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB). METHODS: Patients undergoing OPCAB were classified into three groups according to their E/e' ratio: (i) normal E/e' <8; (ii) undetermined E/e' ≥8 and ≤15; and (iii) elevated E/e' >15. Among those with E/e' between 8 and 15, patients with elevated LV filling pressure were further identified by comprehensive Doppler examination. These patients were classified as having a high LV filling pressure, together with patients who had E/e' ratios >15. Univariate and multivariate regression analyses were used to evaluate the relationship between preoperative variables and composite endpoints for morbidity. RESULTS: In univariate analysis, diabetes mellitus, recent myocardial infarction, chronic obstructive pulmonary disease, serum creatinine (sCr) concentration, E/e' >15, high LV filling pressure, LV ejection fraction, New York Heart Association class III and IV, and use of diuretics were significant risk factors for postoperative morbidity. In multivariate regression analysis of these variables, only sCr (odds ratio 1.4) and E/e' >15 (odds ratio 2.4) or high LV filling pressure (odds ratio 2.8) remained as independent risk factors. CONCLUSIONS: E/e' ratio >15 was a significant predictor of composite endpoints of postoperative morbidity. We suggest that E/e' ratio should be included in the routine preoperative assessment of patients presenting for OPCAB.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/94467
DOI
10.1093/bja/aer188
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Anesthesiology and Pain Medicine
Yonsei Authors
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