The effect of high thoracic epidural anesthesia on systolic and diastolic left ventricular function in patients with coronary artery disease.
In patients with coronary artery disease, vasoconstriction is induced through activation of the sympathetic nervous system. Both alpha1- and alpha2-adrenergic epicardial and microvascular constriction are potent initiators of myocardial ischemia. Attenuation of ischemia has been observed when sympathetic nervous system activity is inhibited by high thoracic epidural anesthesia (HTEA). However, it is still a matter of controversy whether establishing HTEA may correspondingly translate into an improvement of left ventricular (LV) function. To clarify this issue, LV function was quantified serially before and after HTEA using a new combined systolic/diastolic variable of global LV function (myocardial performance index [MPI]) and additional variables that more specifically address systolic (e.g., fractional area change) or diastolic function (e.g., intraventricular flow propagation velocity [Vp]). High thoracic epidural catheters were inserted in 37 patients scheduled for coronary artery surgery, and HTEA was administered in the awake patients. Echocardiographic and hemodynamic measures were recorded before and after institution of HTEA. HTEA induced a significant improvement in diastolic LV function (e.g., Vp changed from 45.1 +/- 16.1 to 53.8 +/- 18.8 cm/s; P < 0.001), whereas indices of systolic function did not change. The change in the diastolic characteristics caused the MPI to improve from 0.51 +/- 0.13 to 0.35 +/- 0.13 (P < 0.001). We conclude that an improvement in cardiac function was due to improved diastolic characteristics.
Schmidt
Christoph
C
Departments of *Anesthesiology and Surgical Intensive-Care Medicine, †Cardiology, and ‡Chest, Heart, and Vascular Surgery, University of Münster Hospital, Germany.
Hinder
Frank
F
Van Aken
Hugo
H
Theilmeier
Gregor
G
Bruch
Christian
C
Wirtz
Stefan P
SP
Bürkle
Hartmut
H
Gühs
Tim
T
Rothenburger
Markus
M
Berendes
Elmar
E
D000368:Aged; D000465:Algorithms; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D001794:Blood Pressure / Q000502:physiology; D003324:Coronary Artery Disease / Q000503:physiopathology*; D003326:Coronary Circulation / Q000502:physiology; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000502:physiology; D009407:Nerve Block; D015588:Observer Variation; D013318:Stroke Volume / Q000502:physiology; D013564:Sympathetic Nervous System / Q000187:drug effects; D013599:Systole; D014655:Vascular Resistance / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*