Prevalence of left ventricular diastolic filling abnormalities in adult cardiac surgical patients: an intraoperative echocardiographic study.
The incidence of left ventricular (LV) diastolic abnormalities in adult cardiac surgical patients has not previously been adequately investigated. The present study was performed to characterize LV diastolic filling patterns by performing transesophageal Doppler echocardiographic (TEE) studies in patients undergoing cardiac surgical procedures and thus indirectly assess diastolic function in these patients. Doppler TEE studies were performed and transmitral flow (TMF) and pulmonary venous flow (PVF) velocities were recorded in 104 patients intraoperatively. Peak early (E) and late (A) TMF velocities and systolic (S) and diastolic (D) forward PVF velocities were assessed and deceleration time (DT) was measured in all patients. For analysis, the study patients were classified into three groups according to the ratio of the TMF E to A velocity curves: group I with E/A ratio less than 1.0, group II with E/A ratio of 1.0 to less than 2.0, and group III with E/A ratio of 2.0 or greater. A filling pattern of abnormal LV relaxation was found in 73 patients (E/A < 1.0), a normal or pseudonormal pattern was present in 27 patients (1.0 < or = E/A < or = 2.0), and restrictive filling in 4 patients (E/A > 2.0). Patients with impaired relaxation had a greater incidence of recent myocardial infarction and congestive heart failure (CHF) than those with normal or pseudonormal filling patterns. Within group II, patients with CHF had higher TMF E deceleration rates and lower PVF S/D ratios compared with those without CHF (P < .05). Doppler echocardiographic examination of TMF and PVF velocities suggests that abnormalities in diastolic function are prevalent in adult cardiac surgical patients.
Lappas
D G
DG
Department of Anesthesiology, Barnes-Jewish Hospital at Washington University Medical Center, Washington University School of Medicine, St Louis, MO 63110-1093, USA.
Skubas
N J
NJ
Lappas
G D
GD
Ruocco
E
E
Tambassis
E
E
Pasque
M
M
D000368:Aged; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003971:Diastole; D018619:Echocardiography, Doppler, Pulsed; D017548:Echocardiography, Transesophageal; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D009200:Myocardial Contraction; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*