Effect of right ventricular dysfunction on dynamic preload indices to predict a decrease in cardiac output after inferior vena cava clamping during liver transplantation.
BACKGROUND
Dynamic preload indices such as stroke volume variation (SVV) and pulse pressure variation (PPV) have yielded false-positive results in patients with right ventricular (RV) dysfunction. We therefore assessed the effect of RV dysfunction on dynamic indices to predict the decrease in cardiac output (CO) during liver transplantation.


METHODS
Hemodynamic parameters were measured before and after inferior vena cava (IVC) clamping in 52 recipients. The RV dysfunction was defined as an RV ejection fraction (RVEF) ≤ 30%. The area under the receiver operating characteristic curve (AUC) sufficient to detect changes in CO (ΔCO) ≥ 20% after IVC clamping in recipients was calculated.


RESULTS
Recipients with RVEF ≤ 30% did not show significant increases in SVV or PPV despite having ΔCO ≥ 20%. In recipients with RVEF > 30%, the threshold value and AUC of SVV predicting a decrease in CO were 10% and 0.755 (compared with an AUC of 0.5, P = .011), respectively, whereas those for PPV were 10% and 0.767 (P = .007), respectively. However, in recipients with RVEF ≤ 30%, the threshold value and AUC of SVV were 10% and 0.638 (P = .305), respectively, whereas those for PPV were 12% and 0.684 (P = .159), respectively.


CONCLUSIONS
These results suggest that dynamic preload indices may not be sufficiently sensitive to detect a CO decrease in liver transplant recipients with RV dysfunction, emphasizing the importance of evaluating RV function when determining the predictability of dynamic indices.
Kim
Y K
YK
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Shin
W J
WJ
Song
J G
JG
Jun
I G
IG
Kim
H Y
HY
Seong
S H
SH
Huh
I Y
IY
Hwang
G S
GS
D000328:Adult; D001795:Blood Pressure Determination; D002302:Cardiac Output / Q000502:physiology*; D003250:Constriction; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006439:Hemodynamics; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation / Q000379:methods / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010092:Oximetry; D013318:Stroke Volume / Q000502:physiology*; D014682:Vena Cava, Inferior / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000503:physiopathology*