Hostname: page-component-76fb5796d-5g6vh Total loading time: 0 Render date: 2024-04-27T03:27:05.569Z Has data issue: false hasContentIssue false
  • English
  • Français

Myocardial performance index during rapidly changing loading conditions: impact of different tidal ventilation

Published online by Cambridge University Press:  01 March 2008

J. Renner ,
E. Cavus ,
M. Gruenewald ,
M. Steinfath ,
J. Scholz ,
G. Lutter ,
M. Steffen  and
B. Bein
J. Renner*
Affiliation:
University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Bielefeld, Germany
E. Cavus
Affiliation:
University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Bielefeld, Germany
M. Gruenewald
Affiliation:
University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Bielefeld, Germany
M. Steinfath
Affiliation:
University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Bielefeld, Germany
J. Scholz
Affiliation:
University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Bielefeld, Germany
G. Lutter
Affiliation:
University Hospital Schleswig-Holstein, Department of Cardiothoracic and Vascular Surgery, Campus Kiel, Bielefeld, Germany
M. Steffen
Affiliation:
Franziskus Hospital, Department of General Internal Medicine, Bielefeld, Germany
B. Bein
Affiliation:
University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Bielefeld, Germany
*
Correspondence to: Jochen Renner, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, D-24105 Kiel, Germany. E-mail: renner@anaesthesie.uni-kiel.de; Tel: +49 431597-3739; Fax: +49 431597-3002
Get access

Summary

Background and objectives

The myocardial performance index is a non-geometric, heart rate-independent echocardiography-derived index of left ventricular performance combining systolic and diastolic function. There is an ongoing debate whether the myocardial performance index is affected by preload or not. Moreover, a systematic evaluation of the effect of changing tidal volume ventilation on the myocardial performance index is still lacking. The aim of our study was to assess whether acute changes in preload and/or different depth of tidal volume ventilation affect the myocardial performance index.

Methods

In all, 14 anesthetized pigs (35 ± 2 kg) were studied during changing tidal volumes (VT 5, 10 and 15 mL kg−1) at baseline, after removal of 500 cm3 of blood (haemorrhage) and after retransfusion of shed blood plus additional 500 cm3 6% hydroxyethyl starch (fluid loading). Echocardiographic measurements at each experimental stage included myocardial performance index, left ventricular end-diastolic area and fractional area change. Central venous pressure, pulmonary capillary wedge pressure, cardiac output and stroke volume index were obtained by a pulmonary artery catheter. Global end-diastolic volume was obtained by transpulmonary thermodilution.

Results

Comparing different loading conditions, we found significant changes in cardiac output, stroke volume index, central venous pressure, pulmonary capillary wedge pressure, global end diastolic volume and left ventricular end-diastolic area, indicating clinically relevant changes in preload. In the haemorrhage group, there was a significant reduction in the myocardial performance index (P < 0.05) independent of tidal volume applied and this was reversed after fluid loading. However, myocardial performance index was significantly impaired (P < 0.05) by high tidal volume ventilation (15 mL kg−1), while tidal volumes of 5 and 10 mL kg−1 had no effect.

Conclusions

The myocardial performance index is largely dependent on changes in preload. Moreover, high tidal volume ventilation significantly impaired the myocardial performance index.

Keywords

ECHOCARDIOGRAPHYMYOCARDIAL CONTRACTIONHAEMORRHAGEVENTILATIONVENTRICULAR FUNCTION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 3 , March 2008 , pp. 217 - 223
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Tei, C, Ling, LH, Hodge, DO et al. . New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function – a study in normals and dilated cardiomyopathy. J Cardiol 1995; 26: 357–366.Google ScholarPubMed
2.Bein, B, Renner, J, Caliebe, D et al. . Sevoflurane but not propofol preserves myocardial function during minimally invasive direct coronary artery bypass surgery. Anesth Analg 2005; 100: 610–616, table of contents.CrossRefGoogle Scholar
3.Bruch, C, Schmermund, A, Marin, D et al. . Tei-index in patients with mild-to-moderate congestive heart failure. Eur Heart J 2000; 21: 1888–1895.CrossRefGoogle ScholarPubMed
4.Dujardin, KS, Tei, C, Yeo, TC et al. . Prognostic value of a Doppler index combining systolic and diastolic performance in idiopathic-dilated cardiomyopathy. Am J Cardiol 1998; 82: 1071–1076.CrossRefGoogle ScholarPubMed
5.Moller, JE, Egstrup, K, Kober, L et al. . Prognostic importance of systolic and diastolic function after acute myocardial infarction. Am Heart J 2003; 145: 147–153.CrossRefGoogle ScholarPubMed
6.Raboisson, MJ, Bourdages, M, Fouron, JC. Measuring left ventricular myocardial performance index in fetuses. Am J Cardiol 2003; 91: 919–921.CrossRefGoogle ScholarPubMed
7.Tei, C, Dujardin, KS, Hodge, DO et al. . Doppler index combining systolic and diastolic myocardial performance: clinical value in cardiac amyloidosis. J Am Coll Cardiol 1996; 28: 658–664.CrossRefGoogle ScholarPubMed
8.Broberg, CS, Pantely, GA, Barber, BJ et al. . Validation of the myocardial performance index by echocardiography in mice: a noninvasive measure of left ventricular function. J Am Soc Echocardiogr 2003; 16: 814–823.CrossRefGoogle ScholarPubMed
9.Borow, KM, Neumann, A, Marcus, RH et al. . Effects of simultaneous alterations in preload and afterload on measurements of left ventricular contractility in patients with dilated cardiomyopathy: comparisons of ejection phase, isovolumetric and end-systolic force-velocity indexes. J Am Coll Cardiol 1992; 20: 787–795.CrossRefGoogle ScholarPubMed
10.Cheung, MM, Smallhorn, JF, Redington, AN, Vogel, M. The effects of changes in loading conditions and modulation of inotropic state on the myocardial performance index: comparison with conductance catheter measurements. Eur Heart J 2004; 25: 2238–2242.CrossRefGoogle ScholarPubMed
11.Lind, L, Andren, B, Arnlov, J. The Doppler-derived myocardial performance index is determined by both left ventricular systolic and diastolic function as well as by afterload and left ventricular mass. Echocardiography 2005; 22: 211–216.CrossRefGoogle ScholarPubMed
12.Lutz, JT, Giebler, R, Peters, J. The ‘TEI-index’ is preload dependent and can be measured by transoesophageal echocardiography during mechanical ventilation. Eur J Anaesthesiol 2003; 20: 872–877.CrossRefGoogle ScholarPubMed
13.Moller, JE, Poulsen, SH, Egstrup, K. Effect of preload alternations on a new Doppler echocardiographic index of combined systolic and diastolic performance. J Am Soc Echocardiogr 1999; 12: 1065–1072.CrossRefGoogle ScholarPubMed
14.Goedje, O, Hoeke, K, Lichtwarck-Aschoff, M et al. . Continuous cardiac output by femoral arterial thermodilution calibrated pulse contour analysis: comparison with pulmonary arterial thermodilution. Crit Care Med 1999; 27: 2407–2412.CrossRefGoogle ScholarPubMed
15.Godje, O, Hoke, K, Goetz, AE et al. . Reliability of a new algorithm for continuous cardiac output determination by pulse-contour analysis during hemodynamic instability. Crit Care Med 2002; 30: 52–58.CrossRefGoogle ScholarPubMed
16.Wesseling, KH, Jansen, JR, Settels, JJ, Schreuder, JJ. Computation of aortic flow from pressure in humans using a nonlinear, three-element model. J Appl Physiol 1993; 74: 2566–2573.CrossRefGoogle ScholarPubMed
17.Sakka, SG, Ruhl, CC, Pfeiffer, UJ et al. . Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med 2000; 26: 180–187.CrossRefGoogle ScholarPubMed
18.Wyatt, HL, Haendchen, RV, Meerbaum, S, Corday, E. Assessment of quantitative methods for 2-dimensional echocardiography. Am J Cardiol 1983; 52: 396–401.CrossRefGoogle ScholarPubMed
19.Parthenakis, FI, Kanakaraki, MK, Kanoupakis, EM et al. . Value of Doppler index combining systolic and diastolic myocardial performance in predicting cardiopulmonary exercise capacity in patients with congestive heart failure: effects of dobutamine. Chest 2002; 121: 1935–1941.CrossRefGoogle ScholarPubMed
20.Quinones, MA, Gaasch, WH, Alexander, JK. Influence of acute changes in preload, afterload, contractile state and heart rate on ejection and isovolumic indices of myocardial contractility in man. Circulation 1976; 53: 293–302.CrossRefGoogle ScholarPubMed
21.Triulzi, MO, Castini, D, Ornaghi, M, Vitolo, E. Effects of preload reduction on mitral flow velocity pattern in normal subjects. Am J Cardiol 1990; 66: 995–1001.CrossRefGoogle ScholarPubMed
22.JrAranda, JM, Weston, MW, Puleo, JA, Fontanet, HL. Effect of loading conditions on myocardial relaxation velocities determined by Doppler tissue imaging in heart transplant recipients. J Heart Lung Transplant 1998; 17: 693–697.Google ScholarPubMed
23.Starling, EH, Visscher, MB. The regulation of the energy output of the heart. J Physiol 1927; 62: 243–261.CrossRefGoogle ScholarPubMed
24.Renner, J, Tonner, PH, Bein, B. Misinterpretation of the TEI-index. Eur J Anaesthesiol 2005; 22: 154–155.CrossRefGoogle ScholarPubMed
25.Glower, DD, Spratt, JA, Snow, ND et al. . Linearity of the Frank–Starling relationship in the intact heart: the concept of preload recruitable stroke work. Circulation 1985; 71: 994–1009.CrossRefGoogle ScholarPubMed