Ketamine reduce left ventricular systolic and diastolic function in patients with ischaemic heart disease

• Published in: Acta anaesthesiologica Scandinavica Vol. 54; no. 9; pp. 1137 - 1144
• Main Authors: JAKOBSEN, C.-J., TORP, P., VESTER, A. E., FOLKERSEN, L., THOUGAARD, A., SLOTH, E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.10.2010; Blackwell
• Subjects: Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Diastole - drug effects; Humans; Ketamine - pharmacology; Male; Medical sciences; Middle Aged; Myocardial Ischemia - physiopathology; Prospective Studies; Systole - drug effects; Ventricular Function, Left - drug effects; Human; Cardiovascular disease; Myocardial ischemia; Glutamate receptor; Coronary heart disease; Myocardial disease; Vascular disease; Ketamine; General anesthetic; Anesthesia; Antagonist; NMDA receptor; Left ventricle performance
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2010.02283.x

Objective: Ketamine may be followed by a general increase in haemodynamics and oxygen consumption, which may be of concern in patients with ischaemic heart disease. The purpose of this study was to evaluate the effect of ketamine on left ventricular (LV) systolic and diastolic function by different modalities of echocardiography and tissue Doppler imaging in patients with ischaemic heart disease. Methods and Results: Prospective observational study of 11 patients acting as own control based on echocardiographic imaging before and after bolus ketamine 0.5 mg/kg. Simpson's 2 D‐volumetric method was used to quantify left ventricular volume and ejection fraction. General global LV deformation was assessed by Speckle tracking ultrasound, systolic LV longitudinal displacement was assessed by Tissue Tracking score index and the diastolic function was evaluated from changes in early‐(E') and atrial (A') peak velocities during diastole. Average heart rate (34%) and blood pressure (35%) increased significantly after ketamine (P<0.0001). Mean tissue tracking score index decreased from 11.2±2.3 to 8.3±2.6 (P=0.005) and Global Speckle tracking 2D strain from 17.7±2.7 to 13.7±3.6 (P=0.0014) indicating a decrease in LV global systolic function. The E'/A' ratio decreased from 1.11±0.43 to 0.81±0.46 (P=0.044) indicating impaired relaxation. Conclusion: Different modalities of echocardiography in combination with tissue Doppler indicate both diminished systolic and diastolic function after ketamine administration in patients with ischaemic heart disease.