Echocardiography-Based Hemodynamic Management of Left Ventricular Diastolic Dysfunction: A Feasibility and Safety Study

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 31; no. 10; pp. 1189 - 1198
• Main Authors: Shillcutt, Sasha K., Montzingo, Candice R., Agrawal, Ankit, Khaleel, Maseeha S., Therrien, Stacey L., Thomas, Walker R., Porter, Thomas R., Brakke, Tara R.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.11.2014
• Subjects: Aged; anesthesia; atrial fibrillation; congestive heart failure; Echocardiography - methods; Echocardiography, Transesophageal - methods; elderly; Feasibility Studies; Female; Follow-Up Studies; Hemodynamics - physiology; Humans; Intraoperative Care - methods; left ventricular diastolic dysfunction; Male; Middle Aged; Observer Variation; Operative Time; Patient Safety; Pilot Projects; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Preoperative Care - methods; Prospective Studies; Reference Values; Risk Assessment; Severity of Illness Index; Single-Blind Method; Surgery, Computer-Assisted - methods; Surgical Procedures, Operative - adverse effects; Surgical Procedures, Operative - methods; transesophageal echocardiography; transthoracic echocardiography; Treatment Outcome; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - diagnostic imaging; atrial fibrillation; left ventricular diastolic dysfunction; elderly; congestive heart failure; transthoracic echocardiography; transesophageal echocardiography; anesthesia
• ISSN: 0742-2822; 1540-8175; 1540-8175
• DOI: 10.1111/echo.12574

Background Patients with left ventricular diastolic dysfunction (LVDD) are at increased risk of postoperative adverse events. The primary aim of this study was to evaluate the safety and feasibility of using echocardiography‐guided hemodynamic management (EGHEM) during surgery in subjects with LVDD compared to conventional management. The feasibility of using echocardiography to direct a treatment algorithm and clinical outcomes were compared for safety between groups. Methods Subjects were screened for LVDD by preoperative transthoracic echocardiography (TTE) and randomized to the conventional or EGHEM group. Subjects in EGHEM received hemodynamic management based on left ventricular filling patterns on transesophageal echocardiography (TEE). Primary outcomes measured were the feasibility to obtain TEE images and follow a TEE‐based treatment algorithm. Safety outcomes also compared the following clinical differences between groups: length of hospitalization, incidence of atrial fibrillation, congestive heart failure (CHF), myocardial infarction, cerebrovascular accident, transient ischemic attack and renal failure measured 30 days postoperatively. Results Population consisted of 28 surgical subjects (14 in conventional group and 14 in EGHEM group). Mean subject age was 73.4 ± 6.7 years (36% male) in conventional group and 65.9 ± 14.4 years (36% male) in EGHEM group. Procedures included orthopedic (conventional = 29%, EGHEM 36%), general (conventional = 50%, EGHEM = 36%), vascular (conventional = 7%, EGHEM = 21%), and thoracic (conventional = 14%, EGHEM = 7%). There was no statistically significant difference in adverse clinical events between the 2 groups. The EGHEM group had less CHF, atrial fibrillation, and shorter length of stay. Conclusions Echocardiography‐guided hemodynamic management of patients with LVDD during surgery is feasible and may be a safe alternative to conventional management.