• J. Cardiothorac. Vasc. Anesth. · Jan 2019

    Observational Study

    The Sum of Early Diastolic Annulus Velocities in the Mitral and Tricuspid Valve Can Predict Adverse Events After Cardiac Surgery.

    • Akira Mukai, Koichi Suehiro, Yohei Fujimoto, Tadashi Matsuura, Katsuaki Tanaka, Tomoharu Funao, Tokuhiro Yamada, Takashi Mori, and Kiyonobu Nishikawa.
    • Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan.
    • J. Cardiothorac. Vasc. Anesth. 2019 Jan 1; 33 (1): 149-156.

    ObjectivesTo assess whether a tissue Doppler imaging (TDI)-based parameter consisting of the sum of early diastolic velocities of the mitral annulus (Me') and tricuspid annulus (Te') can serve as a predictor of adverse outcomes after cardiac surgery.DesignProspective, observational study.SettingUniversity hospital.ParticipantsThe study comprised 100 patients undergoing cardiac surgery.InterventionsNone.Measurements And Main ResultsAfter anesthetic induction, transesophageal echocardiography was performed to obtain the values of the early transmitral flow velocity (E), Me', and Te'. The primary endpoint was the incidence of postoperative major organ morbidity and mortality (MOMM) events, including death, redo surgery, prolonged ventilation, stroke, sternal infection, and dialysis. Receiver operating characteristic and multivariate logistic analyses were used to examine the prognostic performance of TDI-based parameters for predicting MOMM incidence. The secondary endpoint was the incidence of death or rehospitalization for cardiovascular disease within 1 year post-discharge. TDI-based parameters were measured in 87 of the 100 patients enrolled. Me' plus Te' had better prognostic ability (area under the curve 0.771; threshold 13 cm/s; sensitivity 86.7%; specificity 64.9%) than that of Me' or E to Me' (E/Me')% and was an independent predictor of MOMM (odds ratio 0.45; 95% confidence interval 0.28-0.74, p = 0.001), whereas Me' was not. Lower Me' plus Te' (≤13 cm/s) was associated with a significantly higher incidence and earlier onset of cardiovascular events within 1 year post-discharge (p = 0.012).ConclusionsCompared with Me' and E/Me', which traditionally are used for assessing diastolic function, Me' plus Te' showed better prognostic ability for both short- and long-term outcomes of cardiac surgery.Copyright © 2018 Elsevier Inc. All rights reserved.

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