Combination of Static Echocardiographic Indices for the Prediction of Fluid Responsiveness in Patients Undergoing Coronary Surgery: A Pilot Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Anesthetic Management
2.3. Study Protocol
2.4. Study Endpoints
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Responders (n = 40) | Non-Responders (n = 24) | p | |
---|---|---|---|
Age (years) | 66 ± 8 | 65 ± 8 | 0.577 |
Female | 12 (30) | 2 (8) | 0.042 |
Body mass index (kg/m2) | 25.3 ± 2.6 | 23.8 ± 3.1 | 0.037 |
Hypertension | 24 (60) | 17 (71) | 0.382 |
Diabetes mellitus | 12 (30) | 15 (63) | 0.011 |
Cerebrovascular accident | 7 (18) | 0 (0) | 0.039 |
Myocardial infarction (<3 months) | 4 (10) | 2 (8) | 1.000 |
Left main disease (>50% stenosis) | 17 (43) | 10 (42) | 0.948 |
LVEF (%) | 64 ± 6 | 67 ± 8 | 0.227 |
Medications | |||
Statin | 27 (68) | 19 (80) | 0.315 |
Nitrate | 16 (40) | 10 (42) | 0.895 |
Beta blocker | 19 (48) | 14 (58) | 0.401 |
Calcium channel blocker | 20 (50) | 6 (25) | 0.049 |
Renin-angiotensin system antagonist | 23 (58) | 12 (50) | 0.560 |
Patients requiring norepinephrine | 35 (88) | 21 (88) | 1.000 |
Plateau inspiratory pressure (cmH2O) | 15 (14–16) | 15 (14–16) | 0.486 |
Responders (n = 40) | Non-Responders (n = 24) | |||||
---|---|---|---|---|---|---|
Baseline | After Fluid Challenge | p | Baseline | After Fluid Challenge | p | |
HR (bpm) | 59 ± 9 | 55 ± 6 | <0.001 | 57 ± 5 | 55 ± 5 | <0.001 |
MAP (mmHg) | 72 ± 8 | 76 ± 9 | <0.001 | 70 ± 8 | 76 ± 6 | <0.001 |
MPAP (mmHg) | 17 (15–19) | 20 (18–22) | <0.001 | 16 (14–17) | 19 (17–22) | <0.001 |
CI (L/min/m2) | 2.1 (1.9–2.3) | 2.6 (2.3–2.9) * | <0.001 | 2.3 (2.0–2.6) | 2.1 (1.9–2.4) | <0.001 |
SVI (mL/beat/m2) | 35 (32–38) * | 46 (42–52) * | <0.001 | 38 (33–48) | 37 (34–44) | <0.001 |
CVP (mmHg) | 9 (8–11) | 12 (10–13) | <0.001 | 9 (8–10) | 11 (10–13) | <0.001 |
PAOP (mmHg) | 13 (12–14) | 16 (14–17) | <0.001 | 12 (10–14) | 15 (13–18) | <0.001 |
PPV (%) | 13 (8–14) * | 4 (3–6) * | <0.001 | 9 (7–11) | 6 (5–7) | <0.001 |
Baseline | After Fluid Challenge | p1 a | ||
---|---|---|---|---|
LVEDA (cm2) | Responder | 21.1 ± 3.8 | 23.9 ± 3.6 | <0.001 |
Non-responder | 22.5 ± 3.0 | 23.9 ± 2.7 | <0.001 | |
p2 b | 0.140 | 0.990 | ||
E/E’ | Responder | 6.2 (5.6–7.0) | 7.1 (6.1–8.0) | <0.001 |
Non-responder | 8.2 (6.1–9.2) | 8.9 (7.4–9.8) | 0.031 | |
p2 | 0.006 | 0.002 | ||
E’/S’ | Responder | 0.9 ± 0.2 | 1.0 ± 0.2 | 0.004 |
Non-responder | 0.8 ± 0.2 | 0.9 ± 0.2 | 0.035 | |
p2 | 0.024 | 0.099 | ||
E’/A’ | Responder | 1.3 (1.0–1.5) | 1.4 (1.2–1.6) | 0.013 |
Non-responder | 1.1 (0.9–1.4) | 1.1 (0.9–1.5) | 0.147 | |
p2 | 0.140 | 0.048 |
AUROC | 95% CI | p | |
---|---|---|---|
Invasive indices | |||
Central venous pressure | 0.58 | 0.43–0.73 | 0.311 |
Pulmonary artery occlusion pressure | 0.56 | 0.41–0.71 | 0.442 |
Pulse pressure variation | 0.70 | 0.57–0.83 | 0.002 |
Echocardiographic indices | |||
Left ventricular end-diastolic area | 0.60 | 0.46–0.74 | 0.170 |
E/E’ | 0.71 | 0.56–0.85 | 0.006 |
E’/S’ | 0.68 | 0.54–0.82 | 0.017 |
E’/A’ | 0.61 | 0.47–0.75 | 0.140 |
Combination of echocardiographic indices | |||
Left ventricular end-diastolic area with E/E’ | 0.78 | 0.66–0.90 | <0.001 |
Left ventricular end-diastolic area with E’/S’ | 0.68 | 0.54–0.82 | 0.012 |
Left ventricular end-diastolic area with E’/A’ | 0.66 | 0.52–0.80 | 0.026 |
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Kim, H.-B.; Soh, S.; Song, J.-W.; Kim, M.-Y.; Kwak, Y.-L.; Shim, J.-K. Combination of Static Echocardiographic Indices for the Prediction of Fluid Responsiveness in Patients Undergoing Coronary Surgery: A Pilot Study. J. Clin. Med. 2021, 10, 1886. https://doi.org/10.3390/jcm10091886
Kim H-B, Soh S, Song J-W, Kim M-Y, Kwak Y-L, Shim J-K. Combination of Static Echocardiographic Indices for the Prediction of Fluid Responsiveness in Patients Undergoing Coronary Surgery: A Pilot Study. Journal of Clinical Medicine. 2021; 10(9):1886. https://doi.org/10.3390/jcm10091886
Chicago/Turabian StyleKim, Hye-Bin, Sarah Soh, Jong-Wook Song, Min-Yu Kim, Young-Lan Kwak, and Jae-Kwang Shim. 2021. "Combination of Static Echocardiographic Indices for the Prediction of Fluid Responsiveness in Patients Undergoing Coronary Surgery: A Pilot Study" Journal of Clinical Medicine 10, no. 9: 1886. https://doi.org/10.3390/jcm10091886