Echocardiographic predictor of acute heart failure after spine surgery: a novel tissue Doppler index associated with a potentially fatal complication of the operation.
BACKGROUND
Acute heart failure (HF) is a potentially fatal complication after spine surgery.


OBJECTIVE
We sought to identify clinical and echocardiographic predictors of postoperative HF in spine surgery patients.


METHODS
Retrospective observational study.


METHODS
A total of 305 patients (128 men; age, 65 ± 9 years) who underwent spine surgery were consecutively enrolled. A transthoracic echocardiography was performed to all patients before the index operation. Patients with a history of HF or with left ventricular (LV) systolic dysfunction (LV ejection fraction <50%) were excluded.


METHODS
Heart failure was defined according to the Framingham criteria. The presence of postoperative dyspneic symptom and the sign of bilateral ankle edema were recorded by the physicians. Chest X-ray was mandatory for all patients and interpreted by the two physicians, including at least one radiologist.


METHODS
Clinical, operative, and echocardiographic parameters were compared between patents with and without acute HF during the postoperative period (duration, 11 ± 9 days). This study was supported by Boryung Pharmaceutical Company (Seoul, Republic of Korea; 13,440 USD).


RESULTS
Postoperative HF occurred in 31 patients (10%). Compared with those without postoperative HF, these patients were older (73 ± 7 vs. 64 ± 9 years), had longer anesthesia time (7.4 ± 4.2 vs. 3.6 ± 2.1 hours), and were treated with a greater volume of fluid replacement during the operation (3.8 ± 0.7 vs. 1.3 ± 0.1 L) (p<.05 for all). On echocardiographic evaluation, the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity (E/E') was higher (11 vs. 8) and left atrial volume index was larger (20 ± 6 vs. 17 ± 6 mL/m(2)) in patients with HF than in the control group (p<.05 for all), whereas the differences in LV ejection fraction and LV size were not significant. In multivariate analysis, E/E' (odds ratio, 1.399; 95% confidence interval, 1.169-1.674; p<.0001), age, and quantity of replaced volume during surgery were independent predictors of postoperative HF.


CONCLUSIONS
Acute HF after spine surgery was rather common even in previously healthy patients. E/E' reflecting LV filling pressure predicted postoperative HF in patients who underwent spine surgery.
Department of Neurosurgery, Wooridul Spine Hospital, 47-4 Chungdam-dong, Gangnam-gu, Seoul 135-100, Republic of Korea; Department of Cardiology, Sejong Hospital, Sosabon-dong Sosa-gu, Bucheon-si Gyeonggi-do, 420-050, Republic of Korea.
Tae-Hoon
TH
Kim
Department of Gynecology and Obstetrics, Presbyterian Medical Center, Junghwasandong 1-ga, Wansan-gu, Jeonju-si, Jeollabuk-do, 560-832, Republic of Korea.
Jeong-Beom
JB
Mun
Department of Neurosurgery, Wooridul Spine Hospital, 47-4 Chungdam-dong, Gangnam-gu, Seoul 135-100, Republic of Korea.
Eunjung
E
Jung
Department of Neurosurgery, Wooridul Spine Hospital, 47-4 Chungdam-dong, Gangnam-gu, Seoul 135-100, Republic of Korea.
In-Kyong
IK
Jeong
Department of Neurosurgery, Wooridul Spine Hospital, 47-4 Chungdam-dong, Gangnam-gu, Seoul 135-100, Republic of Korea.
Sungwoo
S
Choi
Department of Neurosurgery, Wooridul Spine Hospital, 47-4 Chungdam-dong, Gangnam-gu, Seoul 135-100, Republic of Korea.
Sang-Ho
SH
Lee
Division of Cardiology, Gachon University of Medicine and Science, Gil Hospital, 1198, Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea.
Wook-Jin
WJ
Chung
Division of Cardiology, Gachon University of Medicine and Science, Gil Hospital, 1198, Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea.
Taehoon
T
Ahn
Division of Cardiology, Gachon University of Medicine and Science, Gil Hospital, 1198, Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea. Electronic address: jeff76@gilhospital.com.
Jeonggeun
J
Moon
D000208:Acute Disease; D000368:Aged; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013131:Spine / Q000601:surgery*; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology
Congestive heart failure; Diastolic function; Echocardiography; Prognosis; Spine surgery