PDF(Pubmed)
Abstract：
BACKGROUND: Abnormal diastolic function is an independent predictor of adverse postoperative outcomes. Mitral annular tissue Doppler velocity (e\') is a key parameter for assessing diastolic function. The purpose of this study was to confirm that an acute increase in preload did not significantly impact the intraoperative measurement of e\' and secondarily evaluate the impact of this acute intravascular volume increase on the clinical assessment of diastolic function using a previously described simplified algorithm.
METHODS: This was a prospective, non-randomized study in adult patients undergoing elective cardiac surgeries requiring transesophageal echocardiographic monitoring, arterial pressure and Swan-Ganz catheter placements as part of the surgical procedure. Following baseline echocardiographic and hemodynamic measurements, 500 ml of crystalloid solution was infused over 10 min. Hemodynamic and echocardiographic measurements were repeated 5 min after fluid administration.
RESULTS: Complete data sets were available from 84 of the 100 patients who were enrolled in this study. There was no significant change in the values of e\'. The average baseline was 7.8 ± 2.0 cm/s (95%CI: 7.4, 8.2) and 8.1 ± 2.4 (95%CI: 7.6, 8.6) following the fluid bolus (p = 0.10). All hemodynamic variables associated with increased intravascular volume (central venous pressure, pulmonary arterial pressures and stroke volume variation) changed significantly. The overall distribution of diastolic function grades did not change following fluid administration (p = 0.69). However, there were many individual patient differences. When using this simplified algorithm, functional grading changed in 35 patients. Thirty of these 35 changes were only a single grade shift. 22 patients had worse functional grading after fluid administration while 13 had improved grading. Nine patients with normal diastolic function at baseline demonstrated diastolic dysfunction after fluid administration while 6 patients with baseline dysfunction normalized following the fluid bolus.
CONCLUSIONS: We confirmed that e\' is a robust measurement that is reproducible in the intraoperative setting despite variable vascular volume loading conditions, however, the clinical assessment of diastolic function was still altered in 42% of the patients following an intravenous fluid bolus.
METHODS: This was a prospective, non-randomized study in adult patients undergoing elective cardiac surgeries requiring transesophageal echocardiographic monitoring, arterial pressure and Swan-Ganz catheter placements as part of the surgical procedure. Following baseline echocardiographic and hemodynamic measurements, 500 ml of crystalloid solution was infused over 10 min. Hemodynamic and echocardiographic measurements were repeated 5 min after fluid administration.
RESULTS: Complete data sets were available from 84 of the 100 patients who were enrolled in this study. There was no significant change in the values of e\'. The average baseline was 7.8 ± 2.0 cm/s (95%CI: 7.4, 8.2) and 8.1 ± 2.4 (95%CI: 7.6, 8.6) following the fluid bolus (p = 0.10). All hemodynamic variables associated with increased intravascular volume (central venous pressure, pulmonary arterial pressures and stroke volume variation) changed significantly. The overall distribution of diastolic function grades did not change following fluid administration (p = 0.69). However, there were many individual patient differences. When using this simplified algorithm, functional grading changed in 35 patients. Thirty of these 35 changes were only a single grade shift. 22 patients had worse functional grading after fluid administration while 13 had improved grading. Nine patients with normal diastolic function at baseline demonstrated diastolic dysfunction after fluid administration while 6 patients with baseline dysfunction normalized following the fluid bolus.
CONCLUSIONS: We confirmed that e\' is a robust measurement that is reproducible in the intraoperative setting despite variable vascular volume loading conditions, however, the clinical assessment of diastolic function was still altered in 42% of the patients following an intravenous fluid bolus.
摘要：
背景：舒张功能异常是术后不良结局的独立预测因素。二尖瓣环组织多普勒速度(e')是评估舒张功能的关键参数。本研究的目的是确认预负荷的急性增加并不显著影响术中e'的测量，并使用先前描述的简化算法对舒张功能的临床评估进行二次评估。
方法：这是一个前瞻性的，接受需要经食管超声心动图监测的择期心脏手术的成年患者的非随机研究，动脉压和Swan-Ganz导管放置作为外科手术的一部分。基线超声心动图和血流动力学测量后，在10分钟内注入500ml的类晶体溶液。液体给药后5分钟重复进行血液动力学和超声心动图测量。
结果：完整的数据集可从参与本研究的100名患者中的84名获得。e\'的值没有显著变化。流体推注后的平均基线为7.8±2.0cm/s(95CI:7.4,8.2)和8.1±2.4(95CI:7.6,8.6)(p=0.10)。与血管内容量增加相关的所有血液动力学变量（中心静脉压，肺动脉压和每搏输出量变化）显着变化。液体给药后，舒张功能等级的总体分布没有变化（p=0.69）。然而,有许多患者的个体差异。当使用这个简化算法时，35例患者的功能分级发生了变化。在这35个更改中，有30个只是单一的等级转变。22例患者在液体给药后功能分级较差，而13例改善了分级。9例基线时舒张功能正常的患者在液体给药后表现出舒张功能障碍，而6例基线功能障碍的患者在液体推注后恢复正常。
结论：我们证实，e'是一种可靠的测量值，尽管血管容积负荷条件变化，但在术中仍可重复，然而,42%的患者进行静脉推注后,其舒张功能的临床评估仍有改变.
方法：这是一个前瞻性的，接受需要经食管超声心动图监测的择期心脏手术的成年患者的非随机研究，动脉压和Swan-Ganz导管放置作为外科手术的一部分。基线超声心动图和血流动力学测量后，在10分钟内注入500ml的类晶体溶液。液体给药后5分钟重复进行血液动力学和超声心动图测量。
结果：完整的数据集可从参与本研究的100名患者中的84名获得。e\'的值没有显著变化。流体推注后的平均基线为7.8±2.0cm/s(95CI:7.4,8.2)和8.1±2.4(95CI:7.6,8.6)(p=0.10)。与血管内容量增加相关的所有血液动力学变量（中心静脉压，肺动脉压和每搏输出量变化）显着变化。液体给药后，舒张功能等级的总体分布没有变化（p=0.69）。然而,有许多患者的个体差异。当使用这个简化算法时，35例患者的功能分级发生了变化。在这35个更改中，有30个只是单一的等级转变。22例患者在液体给药后功能分级较差，而13例改善了分级。9例基线时舒张功能正常的患者在液体给药后表现出舒张功能障碍，而6例基线功能障碍的患者在液体推注后恢复正常。
结论：我们证实，e'是一种可靠的测量值，尽管血管容积负荷条件变化，但在术中仍可重复，然而,42%的患者进行静脉推注后,其舒张功能的临床评估仍有改变.
