Echocardiographic predictor of acute heart failure after spine surgery: a novel tissue Doppler index associated with a potentially fatal complication of the operation

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• 作者：Tae-Hoon Kim ; MD^a ; ^b ; Jeong-Beom Mun ; MD^c ; Eunjung Jung ; MD^a ; In-Kyong Jeong ; MD^a ; Sungwoo Choi ; MD^a ; Sang-Ho Lee ; MD ; PhD^a ; Wook-Jin Chung ; MD ; PhD^d ; Taehoon Ahn ; MD ; PhD^d ; Jeonggeun Moon ; MD^d ; ^{jeff76@gilhospital.com" class="auth_mail}
• 关键词：Spine surgery ; Prognosis ; Congestive heart failure ; Echocardiography ; Diastolic function
• 刊名：The Spine Journal
• 出版年：1 May, 2014
• 年：2014
• 卷：14
• 期：5
• 页码：782-788
• 全文大小：549 K

文摘

Background context

Acute heart failure (HF) is a potentially fatal complication after spine surgery.

Purpose

We sought to identify clinical and echocardiographic predictors of postoperative HF in spine surgery patients.

Study design

Retrospective observational study.

Patient sample

A total of 305 patients (128 men; age, 65卤9 years) who underwent spine surgery were consecutively enrolled. A transthoracic echocardiography was performed to all patients before the index operation. Patients with a history of HF or with left ventricular (LV) systolic dysfunction (LV ejection fraction <50%) were excluded.

Outcome measures

Heart failure was defined according to the Framingham criteria. The presence of postoperative dyspneic symptom and the sign of bilateral ankle edema were recorded by the physicians. Chest X-ray was mandatory for all patients and interpreted by the two physicians, including at least one radiologist.

Methods

Clinical, operative, and echocardiographic parameters were compared between patents with and without acute HF during the postoperative period (duration, 11卤9 days). This study was supported by Boryung Pharmaceutical Company (Seoul, Republic of Korea; 13,440 USD).

Results

Postoperative HF occurred in 31 patients (10%). Compared with those without postoperative HF, these patients were older (73卤7 vs. 64卤9 years), had longer anesthesia time (7.4卤4.2 vs. 3.6卤2.1 hours), and were treated with a greater volume of fluid replacement during the operation (3.8卤0.7 vs. 1.3卤0.1 L) (p<.05 for all). On echocardiographic evaluation, the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity (E/E鈥? was higher (11 vs. 8) and left atrial volume index was larger (20卤6 vs. 17卤6 mL/m²) in patients with HF than in the control group (p<.05 for all), whereas the differences in LV ejection fraction and LV size were not significant. In multivariate analysis, E/E鈥?(odds ratio, 1.399; 95% confidence interval, 1.169-1.674; p<.0001), age, and quantity of replaced volume during surgery were independent predictors of postoperative HF.

Conclusions

Acute HF after spine surgery was rather common even in previously healthy patients. E/E鈥?reflecting LV filling pressure predicted postoperative HF in patients who underwent spine surgery.