Prognostic value of a tissue Doppler-derived index of left ventricular filling pressure on composite morbidity after off-pump coronary artery bypass surgery
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 e...
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| Veröffentlicht in: | British journal of anaesthesia : BJA 2011-10, Vol.107 (4), p.519-524 |
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| creator | Jun, N.H. Shim, J.K. Kim, J.C. Kwak, Y.L. |
| description | 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).
Patients undergoing OPCAB were classified into three groups according to their E/e′ ratio: (i) normal 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.
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.
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. |
| doi_str_mv | 10.1093/bja/aer188 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 0007-0912</identifier><identifier>EISSN: 1471-6771</identifier><identifier>DOI: 10.1093/bja/aer188</identifier><identifier>PMID: 21697182</identifier><identifier>CODEN: BJANAD</identifier><language>eng</language><publisher>Oxford: Elsevier Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Arrhythmias, Cardiac - physiopathology ; Biological and medical sciences ; Coronary Artery Bypass, Off-Pump - adverse effects ; Coronary Artery Bypass, Off-Pump - mortality ; diastolic dysfunction ; E/e′ value ; Echocardiography, Doppler, Pulsed - methods ; Endpoint Determination ; Female ; Humans ; Length of Stay ; Logistic Models ; LV filling pressure ; Male ; Medical sciences ; Middle Aged ; Mitral Valve - physiology ; off-pump coronary artery bypass ; Perioperative Care ; Postoperative Complications - epidemiology ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Risk Factors ; Ventricular Function, Left - physiology</subject><ispartof>British journal of anaesthesia : BJA, 2011-10, Vol.107 (4), p.519-524</ispartof><rights>2011 The Author(s)</rights><rights>The Author [2011]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com 2011</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c427t-a735b1244d29405fcdffc4c0bf8406afa6b4321673982a61876315316062cf2e3</citedby><cites>FETCH-LOGICAL-c427t-a735b1244d29405fcdffc4c0bf8406afa6b4321673982a61876315316062cf2e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24540406$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21697182$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jun, N.H.</creatorcontrib><creatorcontrib>Shim, J.K.</creatorcontrib><creatorcontrib>Kim, J.C.</creatorcontrib><creatorcontrib>Kwak, Y.L.</creatorcontrib><title>Prognostic value of a tissue Doppler-derived index of left ventricular filling pressure on composite morbidity after off-pump coronary artery bypass surgery</title><title>British journal of anaesthesia : BJA</title><addtitle>Br J Anaesth</addtitle><addtitle>Br J Anaesth</addtitle><description>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).
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.
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.
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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Arrhythmias, Cardiac - physiopathology</subject><subject>Biological and medical sciences</subject><subject>Coronary Artery Bypass, Off-Pump - adverse effects</subject><subject>Coronary Artery Bypass, Off-Pump - mortality</subject><subject>diastolic dysfunction</subject><subject>E/e′ value</subject><subject>Echocardiography, Doppler, Pulsed - methods</subject><subject>Endpoint Determination</subject><subject>Female</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Logistic Models</subject><subject>LV filling pressure</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mitral Valve - physiology</subject><subject>off-pump coronary artery bypass</subject><subject>Perioperative Care</subject><subject>Postoperative Complications - epidemiology</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Ventricular Function, Left - physiology</subject><issn>0007-0912</issn><issn>1471-6771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc-KFDEQxoMo7rh68QEkFxGEdpN0Ouk-yvoXFvSg5yadrgxZ0p1YSQ_Ou_iwZpnRvYinShW_-sJXHyHPOXvD2dBeTbfmygDyvn9Adlxq3iit-UOyY4zphg1cXJAnOd8yxrUYusfkQnA1aN6LHfn1FeN-jbl4Sw8mbECjo4YWn3N9v4spBcBmBvQHmKlfZ_h5RwRwhR5gLejtFgxS50Pw654mhLqJVWalNi4pZl-ALhEnP_typMYVwKrgmrQtqSIYV4N1jnV-pNMxmZxpVdjX9il55EzI8OxcL8n3D--_XX9qbr58_Hz99qaxUujSGN12ExdSzmKQrHN2ds5KyybXS6aMM2qSbbWs26EXRvFeq5Z3LVdMCesEtJfk1Uk3YfyxQS7j4rOFEMwKcctj3_etZEJ1lXx9Ii3GnBHcmNAv1cDI2XgXxljDGE9hVPjFWXabFpj_on-uX4GXZ8Bka4JDs1qf7znZSVYd3HNxS___UJ44qMc6eMAxWw-rhdkj2DLO0f9r7TeX7rVb</recordid><startdate>20111001</startdate><enddate>20111001</enddate><creator>Jun, N.H.</creator><creator>Shim, J.K.</creator><creator>Kim, J.C.</creator><creator>Kwak, Y.L.</creator><general>Elsevier Ltd</general><general>Oxford University Press</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20111001</creationdate><title>Prognostic value of a tissue Doppler-derived index of left ventricular filling pressure on composite morbidity after off-pump coronary artery bypass surgery</title><author>Jun, N.H. ; Shim, J.K. ; Kim, J.C. ; Kwak, Y.L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c427t-a735b1244d29405fcdffc4c0bf8406afa6b4321673982a61876315316062cf2e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Arrhythmias, Cardiac - physiopathology</topic><topic>Biological and medical sciences</topic><topic>Coronary Artery Bypass, Off-Pump - adverse effects</topic><topic>Coronary Artery Bypass, Off-Pump - mortality</topic><topic>diastolic dysfunction</topic><topic>E/e′ value</topic><topic>Echocardiography, Doppler, Pulsed - methods</topic><topic>Endpoint Determination</topic><topic>Female</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Logistic Models</topic><topic>LV filling pressure</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mitral Valve - physiology</topic><topic>off-pump coronary artery bypass</topic><topic>Perioperative Care</topic><topic>Postoperative Complications - epidemiology</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Ventricular Function, Left - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jun, N.H.</creatorcontrib><creatorcontrib>Shim, J.K.</creatorcontrib><creatorcontrib>Kim, J.C.</creatorcontrib><creatorcontrib>Kwak, Y.L.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of anaesthesia : BJA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jun, N.H.</au><au>Shim, J.K.</au><au>Kim, J.C.</au><au>Kwak, Y.L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic value of a tissue Doppler-derived index of left ventricular filling pressure on composite morbidity after off-pump coronary artery bypass surgery</atitle><jtitle>British journal of anaesthesia : BJA</jtitle><stitle>Br J Anaesth</stitle><addtitle>Br J Anaesth</addtitle><date>2011-10-01</date><risdate>2011</risdate><volume>107</volume><issue>4</issue><spage>519</spage><epage>524</epage><pages>519-524</pages><issn>0007-0912</issn><eissn>1471-6771</eissn><coden>BJANAD</coden><abstract>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).
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.
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.
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.</abstract><cop>Oxford</cop><pub>Elsevier Ltd</pub><pmid>21697182</pmid><doi>10.1093/bja/aer188</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Arrhythmias, Cardiac - physiopathology Biological and medical sciences Coronary Artery Bypass, Off-Pump - adverse effects Coronary Artery Bypass, Off-Pump - mortality diastolic dysfunction E/e′ value Echocardiography, Doppler, Pulsed - methods Endpoint Determination Female Humans Length of Stay Logistic Models LV filling pressure Male Medical sciences Middle Aged Mitral Valve - physiology off-pump coronary artery bypass Perioperative Care Postoperative Complications - epidemiology Predictive Value of Tests Prognosis Prospective Studies Risk Factors Ventricular Function, Left - physiology |
| title | Prognostic value of a tissue Doppler-derived index of left ventricular filling pressure on composite morbidity after off-pump coronary artery bypass surgery |
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