• Feroze Mahmood, Robina Matyal, Andrew Maslow, Balachundar Subramaniam, John Mitchell, Peter Panzica, Swaminathan Karthik, and Philip Hess.
• Department of Anesthesia and Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. fmahmood@bidmc.harvard.edu
• J. Cardiothorac. Vasc. Anesth. 2008 Oct 1;22(5):706-12.

ObjectivePerioperative measurement of the myocardial performance index (MPI) with transesophageal echocardiography in patients undergoing elective abdominal aortic aneurysm repair and its association with outcome.DesignA prospective observational study.SettingA tertiary care university hospital.ParticipantsPatients undergoing elective abdominal aortic aneurysm repair.InterventionPerioperative transesophageal echocardiography.MeasurementsFifty-one consecutive patients undergoing elective abdominal aortic aneurysm repair were enrolled in the study. The MPI was calculated by using pulse-wave Doppler from the midesophageal window and the deep transgastric position of the probe. In addition, diastolic function was measured as the slope of the transmitral flow propagation velocity, and ejection fraction was calculated as a measure of ventricular systolic function. Comparisons between subjects with uncomplicated versus adverse outcomes were made by using a Mann-Whitney U test. Comparison of the incidence of adverse outcome among subjects with normal and elevated MPIs was made by using a Fisher exact test. Statistical significance was set at p < 0.05.ResultsIt was possible to calculate MPI in all patients with transesophageal echocardiography perioperatively. Patients with adverse postoperative outcomes had an elevated MPI as compared with those without any adverse outcome (0.50 v 0.30, p < 0.001). Also, an MPI of > or = 0.36 was associated with a statistically significant higher incidence of complications (congestive heart failure/prolonged intubation) (p < 0.001).ConclusionsThe MPI is an easily obtained echocardiographic measure of global ventricular performance, which can be measured perioperatively and may be useful as a prospective risk stratification index for patients undergoing elective abdominal aortic aneurysm surgery.

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