Effects of acute decrease in systemic afterload on accuracy of Doppler-derived left ventricular rate of pressure rise measurement in anesthetized patients

• Published in: Journal of the American Society of Echocardiography Vol. 14; no. 12; p. 1161
• Main Authors: Broka, S M, Dubois, P E, Jamart, J, Joucken, K L
• Format: Journal Article
• Language: English
• Published: United States 01.12.2001
• Subjects: Aged; Anesthesia; Anesthetics, Intravenous; Cardiac Output; Coronary Artery Bypass; Echocardiography, Transesophageal; Female; Heart Rate; Humans; Male; Middle Aged; Myocardial Contraction - physiology; Systole - physiology; Ventricular Function, Left - physiology; Ventricular Pressure
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1067/mje.2001.115457

This study was designed to describe exactly the effects of acute decrease in systemic afterload on the accuracy of Doppler-derived left ventricular rate of pressure rise (LV DeltaP/Delta(t)) measurements compared with other routinely used indices of systolic function. Twelve patients scheduled for coronary artery bypass grafting were studied. After induction of anesthesia (T0), afterload was modified by incremental administrations of nicardipine (T1-4). At each step of the procedure, thermodilution-derived cardiac index, left ventricular (LV) fractional area change, and LV DeltaP/Delta(t) were measured, and systemic vascular resistances were calculated. During the procedure, the systemic vascular resistances decrease averaged 13.4%. Systemic vascular resistances were correlated with LV DeltaP/Delta(t) (r = 0.843, P =.003) but inversely correlated with cardiac index (r = -0.782, P =.005) and LV fractional area change (r = -0.887, P =.003). In conclusion, and inversely to cardiac index or LV fractional area change, LV DeltaP/Delta(t) does not overestimate LV contractility in the presence of an acute decrease in systemic afterload.