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Contractile reserve of valvular heart diseases echocardiographically evaluated by epinephrine loading before and
Insights
Epinephrine-induced echocardiographic measurements, including left ventricular posterior wall excursion (PWE), effectively predict cardiac contractile reserve and postoperative outcomes in valvular heart disease patients. Low PWE indicates a higher risk of severe cardiac failure post-surgery.
Area of Science:
- Cardiology
- Cardiac Physiology
- Echocardiography
Background:
- Assessing cardiac contractile reserve is crucial for managing valvular heart disease and atrial septal defects.
- Echocardiography offers a non-invasive method to evaluate cardiac function.
Purpose of the Study:
- To evaluate cardiac contractile reserve using echocardiography after epinephrine loading in patients with acquired valvular heart disease and atrial septal defect.
- To determine the predictive value of echocardiographic parameters for postoperative cardiac function and recovery.
Main Methods:
- Echocardiographic studies were performed on 59 patients with acquired valvular heart disease and 13 with atrial septal defect.
- Epinephrine loading was administered, and left ventricular posterior wall excursion (PWE) and mean left ventricular posterior wall velocity (mPWV) were measured.
- Patients were categorized into three groups based on PWE response to epinephrine.
Main Results:
- PWE and mPWV correlated with stroke volume measured by thermodilution.
- Patients in Group I (PWE < 10 mm after 2 µg/min epinephrine) were at high risk for severe postoperative cardiac failure.
- Decreased PWE, mPWV, mean velocity of circumferential fiber shortening (mVcf), and ejection fraction (EF) preoperatively suggested poor recovery.
Conclusions:
- Echocardiographically derived PWE and mPWV are reliable indicators of cardiac contractile reserve.
- Inotropic stimulation via epinephrine is a valuable tool for predicting cardiac contractile reserve.
- Surgical treatment is recommended for patients with low cardiac function, as improvement is possible despite preoperative indicators of poor recovery.
Abstract:
In order to evaluate cardiac contractile reserve, echocardiographic studies were performed on 59 patients with acquired valvular heart disease and 13 patients with atrial septal defect. After epinephrine loading, the 59 patients were classified into three groups. In group I, echocardiographically-obtained left ventricular posterior wall excursion (PWE) remained below 10 mm after the administration of 2 microgram/min epinephrine. This group included patients with PWE below 10 mm after 1 microgram/min epinephrine loading but who could not endure the 2 microgram/min infusion because of significant adverse effects. In group II, PWE was less than 10 mm before the loading, but exceeded 10 mm after the administration of 1 or 2 microgram/min epinephrine loading. In group III, PWE exceeded 10 mm without stress. The conclusions derived from our data are as follows: The PWE and mean left ventricular posterior wall velocity (mPWV) obtained by echocardiography reflect the stroke volume derived from the thermodilution technique. It is possible to estimate the cardiac contractile force in patients who have a paradoxical motion of the interventricular septum, in the preoperative and even in the early postoperative periods. Patients whose PWE and mPWV are less than 10 mm and 35 mm/sec, respectively, after 2 microgram/min loading of epinephrine (group I), are likely to have severe cardiac failure after surgery. Inotropic stimulation is considered to be a very useful indicator for prediction of cardiac contractile reserve. Patients having decreased PWE, mPWV, mVcf and EF before surgery may have arrested recovery in both short- or long-term follow-up. However, surgical treatment is recommended for these patients with low cardiac function, because some improvement can be expected after surgery.