Echocardiography-based hemodynamic management of left ventricular diastolic dysfunction: A feasibility and safety study

Sasha K. Shillcutt, Candice R. Montzingo, Ankit Agrawal, Maseeha S. Khaleel, Stacey L. Therrien, Walker R. Thomas, Thomas R. Porter, Tara R. Brakke

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1189-1198
Number of pages10
JournalEchocardiography
Volume31
Issue number10
DOIs
StatePublished - Nov 1 2014

Keywords

  • Anesthesia
  • Atrial fibrillation
  • Congestive heart failure
  • Elderly
  • Left ventricular diastolic dysfunction
  • Transesophageal echocardiography
  • Transthoracic echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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