title: Pulse pressure variation is not a valid predictor of fluid responsiveness in patients with elevated left ventricular filling pressure.
abstract: OBJECTIVE
  The purpose of this study was to test the hypothesis that the predictive ability of pulse pressure variation (PPV) for fluid responsiveness would be altered in patients with elevated left ventricular (LV) filling pressure.
  
  
  METHODS
  According to the preoperative echocardiographic assessment of the ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/E'), patients undergoing surgical coronary revascularization were classified into normal (n=34, E/E'<8) and high (n=34, E/E'>15) LV filling pressure group. After anesthetic induction, PPV and hemodynamic data were measured before and after 6 mL/kg of colloid administration. Fluid responsiveness was defined as 12% or more increase in stroke volume index assessed by pulmonary artery catheter and tested by the area under the receiver operating characteristic curve (AUROC).
  
  
  RESULTS
  The AUROCs of PPV in the normal and high filling pressure group were 0.829 (95% confidence interval [CI], 0.661-0.963; P<.001) and 0.583 (95% CI, 0.402-0.749; P=.110), respectively. The AUROCs of cardiac filling pressures and right ventricular end-diastolic volume index did not show statistical significance in both groups.
  
  
  CONCLUSIONS
  None of the assessed preload indices including PPV were able to predict fluid responsiveness in patients with elevated LV filling pressure.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University Health System, Seoul, 120-752, South Korea; Anesthesia and Pain Research Institute, Yonsei University Health System, Seoul, 120-752, South Korea.
authors.forename: Jae-Kwang
authors.initials: JK
authors.lastname: Shim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University Health System, Seoul, 120-752, South Korea; Anesthesia and Pain Research Institute, Yonsei University Health System, Seoul, 120-752, South Korea.
authors.forename: Jong-Wook
authors.initials: JW
authors.lastname: Song
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University Health System, Seoul, 120-752, South Korea; Anesthesia and Pain Research Institute, Yonsei University Health System, Seoul, 120-752, South Korea.
authors.forename: Young
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Anesthesiology and Pain Medicine, National Health Insurance Service Ilsan Hospital, Goyang City, Gyeonggi-do, 410-719, South Korea.
authors.forename: Ji-Ho
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University Health System, Seoul, 120-752, South Korea.
authors.forename: Hye-Min
authors.initials: HM
authors.lastname: Kang
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University Health System, Seoul, 120-752, South Korea; Anesthesia and Pain Research Institute, Yonsei University Health System, Seoul, 120-752, South Korea. Electronic address: ylkwak64@gmail.com.
authors.forename: Young-Lan
authors.initials: YL
authors.lastname: Kwak
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D003102:Colloids / Q000008:administration & dosage; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D005440:Fluid Therapy; D006352:Heart Ventricles / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011674:Pulse; D012372:ROC Curve; D013318:Stroke Volume / Q000502:physiology*
chemical_list: D003102:Colloids
keywords: Filling pressure; Fluid responsiveness; Left ventricle; Pulse pressure variation