Table 2.
Echocardiographic and hemodynamic parameters during surgery (N = 97). Certain echocardiographic and perioperative variables were not available in all patients; thus for these variables, N < 97.
| Intraoperative Variables | N | Beginning of surgery (mean ± SD) |
End of surgery (mean ± SD) |
Change (97.6% CI) |
P* |
|---|---|---|---|---|---|
| Strain and strain rate outcomes | |||||
| Primary analysis | |||||
| Left systolic strain (%) | 72 | −17.0 ± 3.6 | −16.3 ± 4.6 | 0.7 (−0.2, 1.5) | 0.071 |
| Left systolic strain rate (sec−1) | 67 | −0.8 ± 0.2 | −1.1 ± 0.3 | −0.3 (−0.4, −0.2) | <0.001 |
| Secondary analysis | |||||
| Right systolic strain (%) | 54 | −21.8 ± 4.5 | −17.3 ± 4.0 | 4.6 (3.1, 6.0) | <0.001 |
| Right systolic strain rate (sec−1) | 54 | −1.1 ± 0.3 | −1.1 ± 0.3 | 0.0 (−0.1, 0.1) | 0.83 |
|
Additional LV echocardiographic parameters |
Change (95% CI) | ||||
| Ejection fraction (%) | 88 | 62 ± 13 | 66 ± 13 | 5 (2, 7) | <0.001 |
| Mitral lateral annular s' velocity (cm/sec) |
91 | 4.7 ± 1.6 | 6.5 ± 2.7 | 1.8 (1.3, 2.3) | <0.001 |
| Mitral lateral annular e' velocity (cm/sec) |
91 | 5.2 ± 1.8 | 5.3 ± 2.2 | 0.1 (−0.3, 0.5) | 0.64 |
| Mitral lateral annular a' velocity (cm/sec) |
90 | 4.9 ± 2.0 | 5.6 ± 2.5 | 0.7 (0.2, 1.3) | 0.007 |
| Early transmitral flow velocity (E- wave, m/sec) |
92 | 0.8 ± 0.2 | 0.8 ± 0.2 | 0.0 (0.0, 0.1) | 0.093 |
| Late transmitral flow velocity (A- wave, m/sec) |
87 | 0.6 ± 0.2 | 0.7 ± 0.3 | 0.1 (0.0, 0.1) | 0.004 |
| E / A ratio | 87 | 1.4 ± 0.6 | 1.3 ± 0.6 | −0.1 (−0.2, 0.1) | 0.23 |
| E / e' ratio | 89 | 17.7 ± 12.1 | 20.1 ± 24.5 | 2.4 (−1.2, 6.0) | 0.19 |
| Deceleration time (msec) | 89 | 257 ± 79 | 243 ± 73 | −14 (−32, 3) | 0.11 |
| Velocity of propagation (cm/sec) | 91 | 46 ±18 | 46 ± 17 | −1 (6, 4) | 0.74 |
| LV diastolic strain rate (sec−1) | 52 | 1.0 ± 0.3 | 1.1 ± 0.3 | 0.1 (0.0, 0.2) | 0.11 |
| LV end-systolic meridional wall stress (dynes/cm2) |
73 | 77 ± 52 | 48 ± 49 | −29 (−35, −22) | <0.001 |
| LV end-systolic dimension (cm) | 81 | 3.1 ± 1.1 | 2.8 ± 1.0 | −0.3 ± 0.6 | <0.001 |
|
Additional RV echocardiographic parameters |
|||||
| Tricuspid annular plane systolic excursion (cm) |
69 | 1.6 ± 0.4 | 0.9 ± 0.3 | −0.7 (−0.8, −0.6) | <0.001 |
| RV end-diastolic area (cm2) | 68 | 22.84 ± 6.00 | 20.78 ± 5.75 | −2.06 (−3.04, −1.07) | <0.001 |
| RV end-systolic area (cm2) | 68 | 13.18 ± 4.36 | 13.07 ± 4.46 | −0.12 (−0.83, −0.60) | 0.74 |
| RV fractional area change (%) | 68 | 43 ± 11 | 37 ± 12 | −5 (−8, −2) | 0.001 |
| RV early diastolic strain rate (sec−1) | 53 | 1.2 ± 0.3 | 1.1 ± 0.4 | −0.1 (−0.2, 0.1) | 0.15 |
| Aortic valve parameters | |||||
| Peak transvalvular gradient (mmHg) | 83 | 60 ± 19 | 18 ± 7 | −42 (−47, −38) | <0.001 |
| Mean transvalvular gradient (mmHg) |
83 | 36 ± 12 | 8 ± 3 | −28 (−30, −25) | <0.001 |
| Hemodynamic parameters | |||||
| Heart rate (bpm) | 87 | 56 ± 9 | 69 ± 11 | 14 (11, 16) | <0.001 |
| Mean arterial pressure (mmHg) | 96 | 84 ± 11 | 74 ± 10 | −10 (−13, −7) | <0.001 |
| Central venous pressure (mmHg) | 93 | 15 ± 5 | 15 ± 6 | 0 (−2, 1) | 0.56 |
| Pulmonary artery systolic pressure (mmHg) |
69 | 39 ± 9 | 36 ± 11 | −2 (−4, 0) | 0.028 |
| Pulmonary artery diastolic pressure (mmHg) |
68 | 29 ± 7 | 20 ± 7 | −9 (−11, −8) | <0.001 |
| Cardiac output (L/min) | 61 | 4.1 ± 1.0 | 5.0 ± 1.2 | 1.0 (1.0, 1.3) | <0.001 |
| Cardiac index (L/min/m2) | 61 | 2.0 ± 0.5 | 2.5 ± 0.5 | 0.5 (0.3, 0.6) | <0.001 |
| Pharmacologic hemodynamic support at the end of surgery |
|||||
| Epinephrine | 97 | 18 (19%) | |||
| Norepinephrine | 97 | 33 (34%) | |||
| Epinephrine + norepinephrine | 97 | 7 (7%) | |||
| Epinephrine, norepinephrine, +milrinone |
97 | 1 (1%) |
LV = Left ventricle; RV = Right ventricle
*
P values from paired t-test; the significance criterion of 0.024 for two primary analyses, and 0.024 for two secondary analyses after using the O’Brien-Fleming alpha-spending method to adjust for an interim analysis and Bonferroni correction.