Good prognostic value of the intraoperative tissue Doppler-derived index E/e' after non-cardiac surgery.
BACKGROUND
The index E/e' derived from tissue Doppler imaging and pulsed Doppler is the ratio of the early transmitral flow velocity and the early mitral annular velocity and it correlates with left ventricular filling pressure. The purpose of this study was to investigate the relationship between intraoperative E/e' and postoperative cardiovascular complications and length of ICU and hospital stays after a non cardiac surgery.


METHODS
This observational study investigated a total of 82 patients with cardiac disease undergoing non cardiac surgery. Diastolic function was evaluated by conventional echocardiographic pulsed-wave Doppler and TDI. The early peak (E) as well as the late peak (A) filling velocity of the left ventricle (LV) were measured at the mid-esophageal four-chamber at the mitral leaflet tips. Early Peak diastolic filling velocity (e'), Late peak diastolic filling velocity (a') and systolic velocity (s') were obtained from the mid-esophageal four-chamber view placed in the septal and lateral mitral annular sites.


RESULTS
Patients were divided into three groups: E/e'<8 (normal LV filling pressure= 24 patients), E/e' 8-15 (moderately increased =35 patients) and E/e'>15 (severely increased = 23 patients). An elevated E/e' ratio was significantly associated with increased postoperative cardiovascular events, pulmonary congestion (P<0.05) arrhythmias (P<0.05) and with longer ICU and hospital stays (P<0.05).


CONCLUSIONS
This data suggests that the tissue Doppler index E/e' may be a useful indicator for predicting morbid events after non-cardiac surgery. Furthermore, patients with an elevated intraoperative E/e' may need more careful postoperative management.
Department of Anesthesia, Universidad de Valparaíso, Hospital clínico Fach, Santiago, Chile. carol218@vtr.net
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Cabrera Schulmeyer
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Arriaza
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D003422:Critical Care; D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods*; D018619:Echocardiography, Doppler, Pulsed; D017548:Echocardiography, Transesophageal; D005260:Female; D006331:Heart Diseases / Q000503:physiopathology*; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology*; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D011654:Pulmonary Edema / Q000453:epidemiology*; D016037:Single-Blind Method; D013514:Surgical Procedures, Operative; D016277:Ventricular Function, Left