title: Reduced myocardial contractility assessed by tissue Doppler echocardiography is associated with increased risk during adrenal surgery of patients with pheochromocytoma: report of a preliminary study.
abstract: BACKGROUND
  Depressed myocardial contractility, although rarely reported in pheochromocytoma, might be underestimated. It may be a determinant of perioperative risk during adrenal surgery.
  
  
  METHODS
  We prospectively studied consecutive patients with pheochromocytoma; myocardial function examined by standard and tissue Doppler echocardiography was compared with matched control subjects. The incidence of hemodynamic collapse during adrenal surgery was measured.
  
  
  RESULTS
  A total of 15 patients were included (8 men, 46 [17] years, hypertension in 10). All but one had a normal left ventricular ejection fraction. However, compared with control subjects, they had a depressed systolic strain rate (SR) (1.8 [2.1] vs 4.1 [2.2] s(-1), P = .007). Furthermore, 6 of 8 patients with systolic SR less than 2 s(-1) experienced intraoperative collapse, versus 1 of 7 with SR greater than 2 s(-1) (P = .041). No association was observed with other variables.
  
  
  CONCLUSIONS
  Patients with pheochromocytoma may have depressed myocardial contractility detected by tissue Doppler echocardiography despite a normal standard echocardiogram. A systolic SR less than 2 s(-1) was associated with an increased risk of perioperative collapse.
authors.affiliation: Department of Cardiology, Cochin Hospital, Paris V René Descartes University, AP-HP, Paris, France. christophe.meune@cch.aphp.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Meune
authors.forename: Jérôme
authors.initials: J
authors.lastname: Bertherat
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
authors.forename: Nicole
authors.initials: N
authors.lastname: Jude
authors.forename: Xavier
authors.initials: X
authors.lastname: Bertagna
authors.forename: Denis
authors.initials: D
authors.lastname: Duboc
authors.forename: Simon
authors.initials: S
authors.lastname: Weber
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D015150:Echocardiography, Doppler; D006801:Humans; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D010673:Pheochromocytoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D010865:Pilot Projects; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*