Left Ventricular Function Diastolic Dysfunction, Fluid Responsiveness
Conditions
Brief summary
Diastolic function may be evaluated by different measurements on transesophageal echocardiography (TEE). They include mitral inflow velocities obtained by pulsed-wave doppler (PW) : peak early diastolic velocity (E) and late diastolic velocity (A). Mitral annulus velocities, early diastolic (e') and late diastolic (a') are obtained by tissue doppler imaging (TDI). The ratio E/e' reflects left ventricular filling pressure and, as such, might be a predictor of fluid responsiveness. The aim of this study is to evaluate the predictive value of the mitral valve E/e' ratio for fluid responsiveness among patients undergoing coronary bypass graft surgery. Fluid responsiveness being defined as an increase in stroke volume of ≥ 15%. After induction of anesthesia, patients will have their diastolic function evaluated by means of E/e' and other measures. They will then be administered an intravenous bolus of 500 mL of Lactate Ringer® along with passive leg raising (PLR). Stroke volume and fluid responsiveness will be assessed by the thermodilution method (Swan-Ganz catheter) and the FloTrac® device. Fluid responders will be compared to non-responders to evaluate the relationship between E/e' ratio and fluid responsiveness.
Interventions
OTHERVolume expansion
Volume expansion with rapid administration of 500 ml of crystalloid
Sponsors
Montreal Heart Institute
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients \>18 yrs, undergoing elective coronary artery bypass grafting or surgery will be included.
Exclusion criteria
* Significant mitral valvular heart disease (mitral regurgitation ≥ 2/4 or stenosis) * Significant right sided valvular heart disease (tricuspid regurgitation ≥ 2/4) * Intracardiac shunts * Emergency surgery * Non-sinusal rythme * Clinical evidence of decompensated heart failure * Clinical evidence of decompensated pulmonary hypertension * Renal insufficiency with creatinine clairance ≤ 30 cc/min or dialysis * Contraindications to TEE, including esophageal disease or unstable cervical spine * CVP ≥ 15 mm Hg or PCWP ≥ 18 mm Hg immediately before fluid infusion
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mitral valve E/e' ratio for prediction of fluid responsiveness | TEE images taken within the 15 minutes before fluid administration and responsiveness evaluation within the 5 minutes following fluid administration and leg raising | TEE evaluation of mitral inflow velocities and mitral annulus velocities measured right before fluid administration as a predictor of fluid responsiveness defined as an increase of 15% or more of the stroke volume |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pulmonary capillary wedge pressure (PCWP) a-wave to v-wave ratio of the for prediction of fluid responsiveness | Waveform measured within the 15 minutes preceding fluid administration and responsiveness evaluation within the 5 minutes following fluid administration and leg raising | a-wave on v-wave ratio of the pulmonary capillary wedge pressure (PCWP) curve for prediction of fluid responsiveness defined as an increase of 15% or more of the stroke volume |
| Pulse pressure variation (PPV) for prediction of fluid responsiveness | PPV measured within the 15 minutes preceding fluid administration and responsiveness evaluation within the 5 minutes following fluid administration and leg raising | Pulse pressure variation (PPV) measured on arterial pressure curve for prediction of fluid responsiveness defined as an increase of 15% or more of the stroke volume |
| Stroke volume variation (SVV) for prediction of fluid responsiveness | SVV measured within the 15 minutes preceding fluid administration and responsiveness evaluation within the 5 minutes following fluid administration and leg raising | Stroke volume variation (SVV) directly measured by FloTrac/Vigileo® with its intrinsic algorithm for prediction of fluid responsiveness defined as an increase of 15% or more of the stroke volume |
Countries
Canada
Outcome results
None listed