Prognostic Value of Tissue Doppler-Derived E/e′ on Early Morbid Events after Cardiac Surgery

Background: The tissue Doppler‐derived surrogate for left ventricular diastolic pressure, E/e′, has been used to prognosticate outcome in a variety of cardiovascular conditions. In this study, we determined the relationship of intraoperative E/e′ to the use of inotropic support, duration of mechanical ventilation (MV), length of intensive care unit stay (ICU‐LOS), and total hospital stay (H‐LOS) in patients requiring cardiac surgery. The records of 245 consecutive patients were retrospectively reviewed to obtain 205 patients who had intraoperative transesophageal echocardiography examinations prior to coronary artery bypass grafting and/or valvular surgery. Cox proportional hazards and logistic regression models were used to analyze the relation between intraoperative E/e′ or LVEF and early postoperative morbidity (H‐LOS, ICU‐LOS, and MV) and the probability that a patient would require inotropic support. With adjustments for other predictors (female gender, hypertension, diabetes, history of myocardial infarction, emergency surgery, renal failure, procedure type, and length of aortic cross‐clamp time), an elevated E/e′ ratio (≥8) was significantly associated with an increased ICU‐LOS (49 versus 41 median h, P = 0.037) and need for inotropic support (P = 0.002) while baseline LVEF was associated with inotropic support alone (P < 0.0001). These data suggest that the tissue Doppler‐derived index of left ventricular diastolic filling pressure may be a useful indicator for predicting early morbid events after cardiac surgery, and may even provide additional information from that of baseline LVEF. Further, patients with elevated preoperative E/e′ may need more careful peri‐ and postoperative management than those patients with E/e′