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Cardiac Loading using Passive Left Atrial Pressurization and Passive Afterload for Graft Assessment
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Effect of right ventricular dysfunction on dynamic preload indices to predict a decrease in cardiac output after

Y K Kim1, W J Shin, J G Song

  • 1Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Transplantation Proceedings
|September 14, 2010
PubMed
Summary

Dynamic preload indices like SVV and PPV may be unreliable for predicting cardiac output (CO) changes in liver transplant patients with right ventricular (RV) dysfunction. RV function assessment is crucial for accurate CO monitoring.

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Area of Science:

  • Anesthesiology
  • Cardiology
  • Transplant Surgery

Background:

  • Dynamic preload indices, such as stroke volume variation (SVV) and pulse pressure variation (PPV), are commonly used to assess fluid responsiveness.
  • These indices have shown limitations and false-positive results in patients with right ventricular (RV) dysfunction.

Purpose of the Study:

  • To evaluate the impact of RV dysfunction on the accuracy of dynamic preload indices in predicting cardiac output (CO) decrease during liver transplantation.
  • To determine if RV dysfunction affects the sensitivity of SVV and PPV in detecting significant CO changes post-inferior vena cava (IVC) clamping.

Main Methods:

  • Hemodynamic parameters were monitored in 52 liver transplant recipients before and after IVC clamping.
  • Right ventricular dysfunction was defined by an RV ejection fraction (RVEF) ≤ 30%.
  • Area under the receiver operating characteristic curve (AUC) was calculated to assess the predictive performance of SVV and PPV for a ≥ 20% decrease in CO.

Main Results:

  • In patients with RVEF ≤ 30% (RV dysfunction), SVV and PPV did not reliably predict a ≥ 20% decrease in CO.
  • In patients with RVEF > 30%, SVV and PPV effectively predicted CO decrease with AUCs of 0.755 and 0.767, respectively.
  • In patients with RVEF ≤ 30%, the predictive accuracy for CO decrease was diminished, with AUCs for SVV and PPV below 0.7 and statistically insignificant.

Conclusions:

  • Dynamic preload indices (SVV, PPV) demonstrate reduced sensitivity in detecting CO decrease in liver transplant recipients with RV dysfunction.
  • Assessing RV function is critical for interpreting the reliability of dynamic preload indices in predicting hemodynamic changes during liver transplantation.