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Effects of preload alterations on peak early diastolic mitral annulus velocities evaluated by tissue Doppler echocardiography

Published online by Cambridge University Press:  04 January 2007

A. A. Jonassen ,
R. Bjørnerheim ,
T. Edvardsen ,
T. Veel  and
K. A. Kirkebøen
A. A. Jonassen
Affiliation:
Ullevål University Hospital, Department of Anaesthesiology, Oslo, Norway
R. Bjørnerheim
Affiliation:
Ullevål University Hospital, Department of Cardiology, Oslo, Norway
T. Edvardsen
Affiliation:
Rikshospitalet University Hospital, Department of Cardiology, Oslo, Norway
T. Veel
Affiliation:
Ullevål University Hospital, Department of Anaesthesiology, Oslo, Norway Feiring Heart Clinic, Feiring, Norway
K. A. Kirkebøen
Affiliation:
Ullevål University Hospital, Department of Anaesthesiology, Oslo, Norway Ullevål University Hospital, Institute for Experimental Medical Research, Oslo, Norway
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Abstract

Summary

Background and objective: Tissue Doppler echocardiography is proposed to be a relatively preload independent tool for assessment of diastolic function. No data exist on anaesthetized patients in whom myocardial contractility, vascular tone and baroreceptor reflexes are depressed. The aim of this study was to evaluate the effects of preload alterations on tissue velocities in patients during general anaesthesia for coronary arterial bypass surgery. Methods: Fifteen patients referred for elective aorto-coronary bypass surgery were examined by tissue Doppler echocardiography. Early diastolic velocities in the septal and lateral portion of the mitral annulus were measured during preload interventions induced by tilting of the operating table in patients during general anaesthesia both before surgery and after chest closure. To verify changes in preload we used right atrial pressure and pulmonary artery occlusion pressure. Results: Tissue velocities in both the septal and lateral portion of the mitral annulus were significantly higher when preload was increased, compared to when it was decreased. Alterations in diastolic velocities in the septal portion of the mitral annulus prior to surgery: 0.8 ± 0.2 cm s−1, P < 0.001, after surgery: 1.1 ± 0.2 cm s−1, P < 0.001. Alterations in diastolic velocities in the lateral portion of the mitral annulus prior to surgery: 1.4 ± 0.2 cm s−1, P < 0.001, after surgery: 1.1 ± 0.3 cm s−1, P < 0.01. Concomitant changes in right atrial pressure and pulmonary artery occlusion pressure were 11 ± 1 and 12 ± 1 mmHg before surgery and 13 ± 1 and 12 ± 1 mmHg after surgery (P < 0.001 for all), respectively. Conclusion: These results show that tissue velocities of the mitral annulus are preload dependent in patients during general anaesthesia both before and after coronary surgery.

Keywords

ANAESTHESIA GENERAL, SURGERY CARDIACCORONARY ARTERY BYPASSECHOCARDIOGRAPHY DOPPLERMYOCARDIAL CONTRACTION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 2 , February 2007 , pp. 159 - 165
Copyright
2007 European Society of Anaesthesiology

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