title: Influence of pneumoperitoneum on left ventricular filling pressures and NT-proBNP levels.
abstract: BACKGROUND
  We recently demonstrated that pneumoperitoneum affects diastolic echocardiographic findings in healthy women scheduled for gynaecologic laparoscopy. No reports have been conducted in order to assess the echocardiographic consequences in hypertensive subjects during laparoscopic procedures.
  
  
  OBJECTIVE
  The aim of this study was to evaluate Left Ventricular filling pressures in hypertensive women with and without diastolic dysfunction, combining the tissue Doppler imaging technique and the plasmatic levels of amino terminal proBNP.
  
  
  METHODS
  Doppler recordings of mitral inflow, tissue Doppler imaging of mitral annulus and N-terminal-proBNP plasmatic levels were obtained in 40 hypertensive women with or without diastolic dysfunction. Measurements were executed in awake patients (T0), after the induction of anesthesia (T1), 10 and 20 minutes after the creation of the pneumoperitoneum (T2 and T3, respectively) and at the end of the surgery (T4). Furthermore, we collected the last blood sample after 12 hours (T5).
  
  
  RESULTS
  The E/Ea ratio for the evaluation of left ventricular filling pressures were higher in the diastolic dysfunction group than in the non diastolic dysfunction and significantly increased after pneumoperitoneum. Pneumoperitoneum increased the plasmatic levels of natriuretic peptide in both groups. At the end of the procedure we did not observe any further significant alteration.
  
  
  CONCLUSIONS
  Pneumoperitoneum produces a consistent increase of ventricular filling pressures in a population of hypertensive patients with and without diastolic dysfunction. Moreover, there is a significant but transient rise in NT-proBNP after gas insufflation in both groups, most accentuated in the diastolic dysfunction group.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy. russoandreamd@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Russo
authors.forename: A
authors.initials: A
authors.lastname: Scagliusi
authors.forename: A
authors.initials: A
authors.lastname: Scarano
authors.forename: F
authors.initials: F
authors.lastname: Bevilacqua
authors.forename: E
authors.initials: E
authors.lastname: Di Stasio
authors.forename: L
authors.initials: L
authors.lastname: Polidori
authors.forename: E
authors.initials: E
authors.lastname: Marana
mesh_terms: D000328:Adult; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain