Prognostic value of a tissue Doppler-derived index of left ventricular filling pressure on composite morbidity after off-pump coronary artery bypass surgery

N. H. Jun, J. K. Shim, J. C. Kim, Younglan Kwak

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background The ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e′) is an indicator of diastolic function that correlates well with left ventricular (LV) filling pressure and is relatively independent of systolic function and rhythm abnormalities. We prospectively evaluated the predictive value of E/e′ for postoperative outcome in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB). Methods Patients undergoing OPCAB were classified into three groups according to their E/e′ ratio: (i) normal E/e′ <8; (ii) undetermined E/e′ <8 and ≤15; and (iii) elevated E/e′ >15. Among those with E/e′ between 8 and 15, patients with elevated LV filling pressure were further identified by comprehensive Doppler examination. These patients were classified as having a high LV filling pressure, together with patients who had E/e′ ratios >15. Univariate and multivariate regression analyses were used to evaluate the relationship between preoperative variables and composite endpoints for morbidity. Results In univariate analysis, diabetes mellitus, recent myocardial infarction, chronic obstructive pulmonary disease, serum creatinine (sCr) concentration, E/e′ >15, high LV filling pressure, LV ejection fraction, New York Heart Association class III and IV, and use of diuretics were significant risk factors for postoperative morbidity. In multivariate regression analysis of these variables, only sCr (odds ratio 1.4) and E/e′ >15 (odds ratio 2.4) or high LV filling pressure (odds ratio 2.8) remained as independent risk factors. Conclusions E/e′ ratio >15 was a significant predictor of composite endpoints of postoperative morbidity. We suggest that E/e′ ratio should be included in the routine preoperative assessment of patients presenting for OPCAB.

Original languageEnglish
Pages (from-to)519-524
Number of pages6
JournalBritish Journal of Anaesthesia
Volume107
Issue number4
DOIs
Publication statusPublished - 2011 Jan 1

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Off-Pump Coronary Artery Bypass
Ventricular Pressure
Coronary Artery Bypass
Morbidity
Odds Ratio
Transplants
Creatinine
Multivariate Analysis
Regression Analysis
Serum
Diuretics
Stroke Volume
Chronic Obstructive Pulmonary Disease
Diabetes Mellitus
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

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title = "Prognostic value of a tissue Doppler-derived index of left ventricular filling pressure on composite morbidity after off-pump coronary artery bypass surgery",
abstract = "Background The ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e′) is an indicator of diastolic function that correlates well with left ventricular (LV) filling pressure and is relatively independent of systolic function and rhythm abnormalities. We prospectively evaluated the predictive value of E/e′ for postoperative outcome in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB). Methods Patients undergoing OPCAB were classified into three groups according to their E/e′ ratio: (i) normal E/e′ <8; (ii) undetermined E/e′ <8 and ≤15; and (iii) elevated E/e′ >15. Among those with E/e′ between 8 and 15, patients with elevated LV filling pressure were further identified by comprehensive Doppler examination. These patients were classified as having a high LV filling pressure, together with patients who had E/e′ ratios >15. Univariate and multivariate regression analyses were used to evaluate the relationship between preoperative variables and composite endpoints for morbidity. Results In univariate analysis, diabetes mellitus, recent myocardial infarction, chronic obstructive pulmonary disease, serum creatinine (sCr) concentration, E/e′ >15, high LV filling pressure, LV ejection fraction, New York Heart Association class III and IV, and use of diuretics were significant risk factors for postoperative morbidity. In multivariate regression analysis of these variables, only sCr (odds ratio 1.4) and E/e′ >15 (odds ratio 2.4) or high LV filling pressure (odds ratio 2.8) remained as independent risk factors. Conclusions E/e′ ratio >15 was a significant predictor of composite endpoints of postoperative morbidity. We suggest that E/e′ ratio should be included in the routine preoperative assessment of patients presenting for OPCAB.",
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Prognostic value of a tissue Doppler-derived index of left ventricular filling pressure on composite morbidity after off-pump coronary artery bypass surgery. / Jun, N. H.; Shim, J. K.; Kim, J. C.; Kwak, Younglan.

In: British Journal of Anaesthesia, Vol. 107, No. 4, 01.01.2011, p. 519-524.

Research output: Contribution to journalArticle

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AU - Kwak, Younglan

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N2 - Background The ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e′) is an indicator of diastolic function that correlates well with left ventricular (LV) filling pressure and is relatively independent of systolic function and rhythm abnormalities. We prospectively evaluated the predictive value of E/e′ for postoperative outcome in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB). Methods Patients undergoing OPCAB were classified into three groups according to their E/e′ ratio: (i) normal E/e′ <8; (ii) undetermined E/e′ <8 and ≤15; and (iii) elevated E/e′ >15. Among those with E/e′ between 8 and 15, patients with elevated LV filling pressure were further identified by comprehensive Doppler examination. These patients were classified as having a high LV filling pressure, together with patients who had E/e′ ratios >15. Univariate and multivariate regression analyses were used to evaluate the relationship between preoperative variables and composite endpoints for morbidity. Results In univariate analysis, diabetes mellitus, recent myocardial infarction, chronic obstructive pulmonary disease, serum creatinine (sCr) concentration, E/e′ >15, high LV filling pressure, LV ejection fraction, New York Heart Association class III and IV, and use of diuretics were significant risk factors for postoperative morbidity. In multivariate regression analysis of these variables, only sCr (odds ratio 1.4) and E/e′ >15 (odds ratio 2.4) or high LV filling pressure (odds ratio 2.8) remained as independent risk factors. Conclusions E/e′ ratio >15 was a significant predictor of composite endpoints of postoperative morbidity. We suggest that E/e′ ratio should be included in the routine preoperative assessment of patients presenting for OPCAB.

AB - Background The ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e′) is an indicator of diastolic function that correlates well with left ventricular (LV) filling pressure and is relatively independent of systolic function and rhythm abnormalities. We prospectively evaluated the predictive value of E/e′ for postoperative outcome in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB). Methods Patients undergoing OPCAB were classified into three groups according to their E/e′ ratio: (i) normal E/e′ <8; (ii) undetermined E/e′ <8 and ≤15; and (iii) elevated E/e′ >15. Among those with E/e′ between 8 and 15, patients with elevated LV filling pressure were further identified by comprehensive Doppler examination. These patients were classified as having a high LV filling pressure, together with patients who had E/e′ ratios >15. Univariate and multivariate regression analyses were used to evaluate the relationship between preoperative variables and composite endpoints for morbidity. Results In univariate analysis, diabetes mellitus, recent myocardial infarction, chronic obstructive pulmonary disease, serum creatinine (sCr) concentration, E/e′ >15, high LV filling pressure, LV ejection fraction, New York Heart Association class III and IV, and use of diuretics were significant risk factors for postoperative morbidity. In multivariate regression analysis of these variables, only sCr (odds ratio 1.4) and E/e′ >15 (odds ratio 2.4) or high LV filling pressure (odds ratio 2.8) remained as independent risk factors. Conclusions E/e′ ratio >15 was a significant predictor of composite endpoints of postoperative morbidity. We suggest that E/e′ ratio should be included in the routine preoperative assessment of patients presenting for OPCAB.

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