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Published on: April 25, 2014
Intra-operative myocardial ischaemia cannot be detected by analysis of transmitral inflow patterns in patients
J Wang1, M D Seeberger, K Skarvan
1University Hospital Basel, Department of Anaesthesia, Basel, Switzerland.
Insights
Doppler assessment of transmitral inflow patterns did not detect myocardial ischemia during coronary artery bypass graft surgery. This method is not a reliable indicator for intraoperative ischemia detection in these patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Transmitral inflow patterns are utilized for myocardial ischemia detection.
- Their diagnostic utility in anesthetized, mechanically ventilated patients during coronary artery bypass graft (CABG) surgery remains unevaluated.
Purpose of the Study:
- To assess the diagnostic value of transmitral inflow patterns for detecting myocardial ischemia during CABG surgery.
Main Methods:
- Transesophageal Doppler echocardiography was used to study transmitral inflow patterns in 43 patients undergoing CABG.
- Peak early (E) and late (A) transmitral velocities and their ratio (E/A) were recorded.
- Myocardial ischemia was confirmed using standard echocardiographic and electrocardiographic criteria.
Main Results:
- Analysis included 31 patients; 16 developed myocardial ischemia during grafting.
- No significant differences in vasoactive drug use, hemodynamic findings, or transmitral inflow patterns (E, A, E/A ratio) were observed between ischemic and non-ischemic groups.
- Transmitral inflow patterns showed no significant changes indicative of ischemia.
Conclusions:
- Doppler analysis of transmitral inflow patterns is insufficient for detecting myocardial ischemia during surgical revascularization.
- This technique lacks diagnostic value for intraoperative ischemia monitoring in CABG patients.
Background And Objective:
Transmitral inflow patterns have been used for detection of myocardial ischaemia. However, its diagnostic value has not been tested in anaesthetized and mechanically ventilated patients undergoing coronary artery bypass graft surgery.
Methods:
Transmitral inflow patterns were studied by transoesophageal Doppler echocardiography in 43 patients undergoing coronary artery bypass graft surgery without cardiopulmonary bypass after opening of the sternum (baseline) and during grafting of the left anterior descending artery. Peak early (E) and peak late (A) transmitral velocities and their ratio (E/A) were recorded. Myocardial ischaemia was defined by standard criteria using two-dimensional echocardiography and seven-lead electrocardiogram.
Results:
Thirty-one patients (64 +/- 8 yr, 9 women) fulfilled the predefined inclusion criteria for analysis. During distal revascularization, 16 patients showed myocardial ischaemia and 15 did not. The use of vasoactive drugs, haemodynamic findings and transmitral inflow patterns were similar in both groups at baseline and during grafting. In the ischaemic group, E was 67.1 +/- 13.9 cm s-1 at baseline and 69.5 +/- 23.2 cm s-1 during grafting, and the E/A ratios were 1.3 +/- 0.3 and 1.4 +/- 0.9, respectively. In the non-ischaemic group, E was 64.0 +/- 17.1 cm s-1 at baseline and 60.9 +/- 14.8 cm s-1 during grafting, and the E/A ratios were 1.4 +/- 0.7 and 1.2 +/- 0.3, respectively.
Conclusions:
Analysis of Doppler findings of transmitral inflow patterns did not allow for detection of myocardial ischaemia during surgical revascularization of the myocardium.
