title: Acute hypovolemia may cause segmental wall motion abnormalities in the absence of myocardial ischemia.
abstract: New segmental wall motion abnormalities (SWMA) detected by echocardiography are considered sensitive and specific markers of myocardial ischemia. However, we have observed new SWMA during pacing-induced reductions in left ventricular filling, which resolved immediately with cessation of the atrial pacing and simultaneous restoration of filling. Therefore, we designed this study to determine whether acute reduction in filling can induce new SWMA in the absence of ischemia. Institution of cardiopulmonary bypass was used as a clinical model of acute reduction in filling, and a beat-by-beat analysis of left ventricular contraction, filling, blood pressures, and electrocardiogram was performed when the drainage of blood to the cardiopulmonary bypass machine rapidly emptied the heart. Acute reduction in filling induced new SWMA in 4 of 38 study patients. All 4 patients had preexisting abnormalities of left ventricular contraction, but translocation of these preexisting SWMA did not explain the new SWMA, nor did myocardial ischemia. We conclude that acute reduction in left ventricular filling can cause new SWMA in the absence of ischemia. This finding limits the usefulness of new SWMA as a marker of ischemia in the presence of acute reduction in filling, such as that secondary to severe hypovolemia.
  
  
  CONCLUSIONS
  This study documented that acute reduction in cardiac filling can be associated with new systolic wall motion abnormalities detected by transesophageal echocardiography in the absence of documented myocardial ischemia. These findings indicate that segmental wall motion may not be a valid marker for ischemia in the setting of acute hypovolemia.
authors.affiliation: Department of Anesthesia, University of California-San Francisco, USA. seeberger@ubaclu.unibas.ch
authors.forename: M D
authors.initials: MD
authors.lastname: Seeberger
authors.forename: M K
authors.initials: MK
authors.lastname: Cahalan
authors.forename: K
authors.initials: K
authors.lastname: Rouine-Rapp
authors.forename: E
authors.initials: E
authors.lastname: Foster
authors.forename: P
authors.initials: P
authors.lastname: Ionescu
authors.forename: M
authors.initials: M
authors.lastname: Balea
authors.forename: S
authors.initials: S
authors.lastname: Merrick
authors.forename: N B
authors.initials: NB
authors.lastname: Schiller
mesh_terms: D001794:Blood Pressure; D001810:Blood Volume; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D003951:Diagnostic Errors; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016277:Ventricular Function, Left