title: Variation of left ventricular outflow tract velocity and global end-diastolic volume index reliably predict fluid responsiveness in cardiac surgery patients.
abstract: OBJECTIVE
  The ability of the global end-diastolic volume index (GEDVI) and respiratory variations in left ventricular outflow tract velocity (ΔVTI(LVOT)) for prediction of fluid responsiveness is still under debate. The aim of the present study was to challenge the predictive power of GEDVI and ΔVTI(LVOT) compared with pulse pressure variation (PPV) and stroke volume variation (SVV) in a large patient population.
  
  
  METHODS
  Ninety-two patients were studied before coronary artery surgery. Each patient was monitored with central venous pressure (CVP), the PiCCO system (Pulsion Medical Systems, Munich, Germany), and transesophageal echocardiography. Responders were defined as those who increased their stroke volume index by greater than 15% (ΔSVI(TPTD) >15%) during passive leg raising.
  
  
  RESULTS
  Central venous pressure showed no significant correlation with ΔSVI(TPTD) (r = -0.06, P = .58), in contrast to PPV (r = 0.71, P < .0001), SVV (r = 0.61, P < .0001), GEDVI (r = -0.54, P < .0001), and ΔVTI(LVOT) (r = 0.54, P < .0001). The best area under the receiver operating characteristic curve (AUC) predicting ΔSVI(TPTD) greater than 15% was found for PPV (AUC, 0.82; P < .0001) and SVV (AUC, 0.77; P < .0001), followed by ΔVTI(LVOT) (AUC, 0.74; P < .0001) and GEDVI (AUC, 0.71; P = .0006), whereas CVP was not able to predict fluid responsiveness (AUC, 0.58; P = .18).
  
  
  CONCLUSIONS
  In contrast to CVP, GEDVI and ΔVTI(LVOT) reliably predicted fluid responsiveness under closed-chest conditions. Pulse pressure variation and SVV showed the highest accuracy.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany. broch@anaesthesie.uni-kiel.de
authors.forename: Ole
authors.initials: O
authors.lastname: Broch
authors.forename: Jochen
authors.initials: J
authors.lastname: Renner
authors.forename: Matthias
authors.initials: M
authors.lastname: Gruenewald
authors.forename: Patrick
authors.initials: P
authors.lastname: Meybohm
authors.forename: Jan
authors.initials: J
authors.lastname: Höcker
authors.forename: Jan
authors.initials: J
authors.lastname: Schöttler
authors.forename: Markus
authors.initials: M
authors.lastname: Steinfath
authors.forename: Berthold
authors.initials: B
authors.lastname: Bein
mesh_terms: D002496:Central Venous Pressure; D001026:Coronary Artery Bypass; D004452:Echocardiography; D005260:Female; D005440:Fluid Therapy; D005858:Germany; D006334:Heart Function Tests / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016277:Ventricular Function, Left