Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-26T21:46:53.340Z Has data issue: false hasContentIssue false
  • English
  • Français

Effects of preload alterations on peak early diastolic mitral annulus velocities evaluated by tissue Doppler echocardiography

Published online by Cambridge University Press:  04 January 2007

A. A. Jonassen ,
R. Bjørnerheim ,
T. Edvardsen ,
T. Veel  and
K. A. Kirkebøen
A. A. Jonassen
Affiliation:
Ullevål University Hospital, Department of Anaesthesiology, Oslo, Norway
R. Bjørnerheim
Affiliation:
Ullevål University Hospital, Department of Cardiology, Oslo, Norway
T. Edvardsen
Affiliation:
Rikshospitalet University Hospital, Department of Cardiology, Oslo, Norway
T. Veel
Affiliation:
Ullevål University Hospital, Department of Anaesthesiology, Oslo, Norway Feiring Heart Clinic, Feiring, Norway
K. A. Kirkebøen
Affiliation:
Ullevål University Hospital, Department of Anaesthesiology, Oslo, Norway Ullevål University Hospital, Institute for Experimental Medical Research, Oslo, Norway
Get access

Abstract

Summary

Background and objective: Tissue Doppler echocardiography is proposed to be a relatively preload independent tool for assessment of diastolic function. No data exist on anaesthetized patients in whom myocardial contractility, vascular tone and baroreceptor reflexes are depressed. The aim of this study was to evaluate the effects of preload alterations on tissue velocities in patients during general anaesthesia for coronary arterial bypass surgery. Methods: Fifteen patients referred for elective aorto-coronary bypass surgery were examined by tissue Doppler echocardiography. Early diastolic velocities in the septal and lateral portion of the mitral annulus were measured during preload interventions induced by tilting of the operating table in patients during general anaesthesia both before surgery and after chest closure. To verify changes in preload we used right atrial pressure and pulmonary artery occlusion pressure. Results: Tissue velocities in both the septal and lateral portion of the mitral annulus were significantly higher when preload was increased, compared to when it was decreased. Alterations in diastolic velocities in the septal portion of the mitral annulus prior to surgery: 0.8 ± 0.2 cm s−1, P < 0.001, after surgery: 1.1 ± 0.2 cm s−1, P < 0.001. Alterations in diastolic velocities in the lateral portion of the mitral annulus prior to surgery: 1.4 ± 0.2 cm s−1, P < 0.001, after surgery: 1.1 ± 0.3 cm s−1, P < 0.01. Concomitant changes in right atrial pressure and pulmonary artery occlusion pressure were 11 ± 1 and 12 ± 1 mmHg before surgery and 13 ± 1 and 12 ± 1 mmHg after surgery (P < 0.001 for all), respectively. Conclusion: These results show that tissue velocities of the mitral annulus are preload dependent in patients during general anaesthesia both before and after coronary surgery.

Keywords

ANAESTHESIA GENERAL, SURGERY CARDIACCORONARY ARTERY BYPASSECHOCARDIOGRAPHY DOPPLERMYOCARDIAL CONTRACTION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 2 , February 2007 , pp. 159 - 165
Copyright
2007 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mandinov L, Eberli FR, Seiler C, Hess OM. Diastolic heart failure. Cardiovasc Res 2000; 45: 813–825.Google Scholar
Garcia MJ, Thomas JD, Klein AL. New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol 1998; 32: 865–875.Google Scholar
Sohn DW, Chai IH, Lee DJet al. Assessment of mitral annulus velocity by Doppler tissue imaging in evaluation of left ventricular diastolic function. J Am Coll Cardiol 1997; 30: 474–480.Google Scholar
Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 1997; 30: 1527–1533.Google Scholar
Aranda JrJM, Weston MW, Puleo JA, Fontanet HL. Effect of loading conditions on myocardial relaxation velocities determined by Doppler tissue imaging in heart transplant recipients. J Heart Lung Transpl 1998; 17: 693–697.Google Scholar
Firstenberg MS, Greenberg NL, Main MLet al. Determinants of diastolic myocardial tissue Doppler velocities: influences of relaxation and preload. J Appl Physiol 2001; 90: 299–307.Google Scholar
Jacques DC, Pinsky MR, Severyn D, Goresan III J. Influence of alterations in loading on mitral annular velocity by tissue Doppler echocardiography and its associated ability to predict filling pressures. Chest 2004; 126: 1910–1918.Google Scholar
Dumesnil JG, Paulin C, Pibarot P, Coulombe D, Arsenault M. Mitral annulus velocities by Doppler tissue imaging: practical implications with regard to preload alterations, sample position, and normal values. J Am Soc Echocardiogr 2002; 15: 1226–1231.Google Scholar
Pai P-Y, Oh JK, Ommen SR, Lusk JL, Jamil Tajik A. Acute preload alteration affects mitral annulus velocities measured by tissue Doppler. Circulation 1999; 100 (Suppl I): 776.Google Scholar
Dincer I, Kumbasar D, Nergisoglu Get al. Assessment of left ventricular diastolic function with Doppler tissue imaging: effects of preload and place of measurements. Int J Cardiovasc Imag 2002; 18: 155–160.Google Scholar
Pavlin EG, Su JY. Inhaled anesthetics – cardiopulmonary pharmacology. In: Miller RD, ed. Anesthesia.New York, USA: Churchill Livingstone Inc, 1994: 125–156.
Bailey PL, Sanley TH. Intravenous anesthetics – intravenous opioid anesthetics. In: Miller RD, ed. Anesthesia.New York, USA: Churchill Livingstone Inc, 1994: 291–388.
Palka P, Lange A, Fleming ADet al. Differences in myocardial velocity gradient measured throughout the cardiac cycle in patients with hypertrophic cardiomyopathy, athletes and patients with left ventricular hypertrophy due to hypertension. J Am Coll Cardiol 1997; 30: 760–768.Google Scholar
Edvardsen T, Aakhus S, Endresen K, Bjørnerheim R, Smiseth OA, Ihlen H. Acute regional myocardial ischemia identified by 2-dimensional multiregion tissue Doppler imaging technique. J Am Soc Echocardiogr 2000; 13: 986–994.Google Scholar
De Boeck BWL, Cramer M-JM, Oh JK, van der Aa RPLM, Jaarsma W. Spectral pulsed tissue Doppler imaging in diastole: a tool to increase our insight in and assessment of diastolic relaxation of the left ventricle. Am Heart J 2003; 146: 411–419.Google Scholar
Stevens WC, Cromwell TH, Halsey MJ, Eger IIEI, Shakespeare TF, Bahlman SH. The cardiovascular effects of a new inhalation anesthetic, Forane, in human volunteers at constant carbondioxide tension. Anesthesiology 1971; 35: 8–16.Google Scholar
Kotrly KJ, Ebert TJ, Vucins E, Igler FO, Barney JA, Kampine JP. Baroreceptor reflex control of heart rate during isofurane anesthesia in humans. Anesthesiology 1984; 60: 173–179.Google Scholar
Housmans PR, Murat I. Comparative effects of halothane, enflurane, and isoflurane in equipotent anesthetic concentrations on isolated ventricular myocardium of the ferret.I. Contractility. Anesthesiology 1988; 69: 451–463.Google Scholar
Eckstein JW, Hamilton WK, McCammond JM. The effect of thiopental on peripheral venous tone. Anesthesiology 1961; 22: 525–528.Google Scholar
Frankl WS, Poole-Wilson PA. Effects of thiopental on tension development, action potential, and exchange of calcium and potassium in rabbit ventricular myocardium. J Cardiovasc Pharmacol 1981; 3: 554–565.Google Scholar
Marty J, Gauzit R, Lefevre Pet al. Effects of diazepam and midazolam on baroreflex control of heart rate and on sympathetic activity in humans. Anesth Analg 1986; 65: 113–119.Google Scholar
Miller RD, Eger II EI, Stevens WC, Gibbons R. Pancuronium-induced tachycardia in relation to alveolar halothane, dose of pancuronium, and prior atropine. Anesthesiology 1975; 42: 352–355.Google Scholar
Stoelting RK. The hemodynamic effects of pancuronium and d-tubocurarine in anesthetized patients. Anesthesiology 1972; 36: 612–615.Google Scholar
Yalcin F, Kaftan A, Muderrisoglu Het al. Is Doppler tissue velocity during early left ventricular filling preload independent? Heart 2002; 87: 336–339.Google Scholar
Firstenberg MS, Levine BD, Garcia MJet al. Relationship of echocardiographic indices to pulmonary capillary wedge pressure in healthy volunteers. J Am Coll Cardiol 2000; 36: 1664–1669.Google Scholar
Pinsky MR. Hemodynamic monitoring in the intensive care unit. Clin Chest Med 2003; 24: 549–560.Google Scholar