title: Prognostic value of tissue Doppler-Derived E/e' on early morbid events after cardiac surgery.
abstract: The tissue Doppler-derived surrogate for left ventricular diastolic pressure, E/e', has been used to prognosticate outcome in a variety of cardiovascular conditions. In this study, we determined the relationship of intraoperative E/e' to the use of inotropic support, duration of mechanical ventilation (MV), length of intensive care unit stay (ICU-LOS), and total hospital stay (H-LOS) in patients requiring cardiac surgery. The records of 245 consecutive patients were retrospectively reviewed to obtain 205 patients who had intraoperative transesophageal echocardiography examinations prior to coronary artery bypass grafting and/or valvular surgery. Cox proportional hazards and logistic regression models were used to analyze the relation between intraoperative E/e' or LVEF and early postoperative morbidity (H-LOS, ICU-LOS, and MV) and the probability that a patient would require inotropic support. With adjustments for other predictors (female gender, hypertension, diabetes, history of myocardial infarction, emergency surgery, renal failure, procedure type, and length of aortic cross-clamp time), an elevated E/e' ratio (>or=8) was significantly associated with an increased ICU-LOS (49 versus 41 median h, P = 0.037) and need for inotropic support (P = 0.002) while baseline LVEF was associated with inotropic support alone (P < 0.0001). These data suggest that the tissue Doppler-derived index of left ventricular diastolic filling pressure may be a useful indicator for predicting early morbid events after cardiac surgery, and may even provide additional information from that of baseline LVEF. Further, patients with elevated preoperative E/e' may need more careful peri- and postoperative management than those patients with E/e' <8.
authors.affiliation: Departments of Anesthesiology and Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA. lgroban@wfubmc.edu
authors.forename: Leanne
authors.initials: L
authors.lastname: Groban
authors.forename: David M
authors.initials: DM
authors.lastname: Sanders
authors.forename: Timothy T
authors.initials: TT
authors.lastname: Houle
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Antonio
authors.forename: Edi C
authors.initials: EC
authors.lastname: Ntuen
authors.forename: David A
authors.initials: DA
authors.lastname: Zvara
authors.forename: Neal D
authors.initials: ND
authors.lastname: Kon
authors.forename: Edward H
authors.initials: EH
authors.lastname: Kincaid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D015150:Echocardiography, Doppler / Q000706:statistics & numerical data*; D054459:Elasticity Imaging Techniques / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome