The effects of load on systolic mitral annular velocity by tissue Doppler imaging.
Tissue Doppler Imaging (TDI) provides information on systolic function through its systolic mitral annulus velocity wave (Sm), reflecting the peak velocity of shortening of the myocardial fibers oriented in the longitudinal direction. In this study, we evaluated the effect of load changes on Sm. Forty-two cardiac surgical patients with left ventricular ejection fraction >60% were consecutively evaluated. In 24 patients, load was changed with an IV bolus of phenylephrine (50-100 microg) or nitroglycerine (300-500 microg); in 18 patients, preload was changed with a rapid infusion of 500 mL of a gelatin solution. The sample volume of TDI was placed at the lateral side of the mitral annulus in the mid-esophageal 4-chamber view. Changing loading conditions with phenylephrine or nitroglycerine had no effect on Sm; the increase of preload in 18 patients resulted in a statistically significant increase of Sm (baseline, 8.4 +/- 2.6 cm/s; after increase of preload, 9.6 +/- 2.5 cm/s; P = 0.001). We conclude that Sm is dependent on changes in preload obtained by volume loading and cannot be recommended as an index of ventricular contractile performance in critically ill patients where significant changes in ventricular filling occur.
*Department of Anesthesiology, Texas Tech University Health Sciences Center, Lubbock, Texas; †Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas; ‡Tulane University, New Orleans, Louisiana; and §Yale University School of Medicine, New Haven, CT.
Alan D
AD
Kaye
Jason M
JM
Hoover
Syed R
SR
Baber
Ikhlass N
IN
Ibrahim
Aaron M
AM
Fields
D000368:Aged; D001026:Coronary Artery Bypass; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000502:physiology*; D009200:Myocardial Contraction / Q000502:physiology*; D005996:Nitroglycerin / Q000494:pharmacology; D010656:Phenylephrine / Q000494:pharmacology; D013599:Systole / Q000502:physiology; D014662:Vasoconstrictor Agents / Q000494:pharmacology; D014665:Vasodilator Agents / Q000494:pharmacology; D016276:Ventricular Function; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology
D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D010656:Phenylephrine; D005996:Nitroglycerin