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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Preoperative diastolic function predicts the onset of left ventricular dysfunction following aortic valve replacement in high-risk patients with aortic stenosis. | Licker et al. Critical Care 2010 14 R101 http ccforum.eom content 14 3 R101 c CRITICAL CARE RESEARCH Open Access Preoperative diastolic function predicts the onset of left ventricular dysfunction following aortic valve replacement in high-risk patients with aortic stenosis Marc Licker 1 Mustafa Cikirikcioglu2 Cidgem Inan1 Vanessa Cartier1 Afksendyios Kalangos2 Thomas Theologou2 Tiziano Cassina3 and John Diaper1 Abstract Introduction Left ventricular LV dysfunction frequently occurs after cardiac surgery requiring inotropic treatment and or mechanical circulatory support. In this study we aimed to identify clinical surgical and echocardiographic factors that are associated with LV dysfunction during weaning from cardiopulmonary bypass CPB in high-risk patients undergoing valve replacement for aortic stenosis. Methods Perioperative data were prospectively collected in 108 surgical candidates with an expected operative mortality 9 . All anesthetic and surgical techniques were standardized. Reduced LV systolic function was defined by an ejection fraction 40 . Diastolic function of the LV was assessed using standard Doppler-derived parameters tissue Doppler Imaging TDI and transmitral flow propagation velocity Vp . Results Doppler-derived pulmonary flow indices and TDI could not be obtained in 14 patients. In the remaining 94 patients poor systolic LV was documented in 14 n 12 and diastolic dysfunction in 84 of patients n 89 all of whom had Vp 50 cm s. During weaning from CPB 38 patients 40 required inotropic and or mechanical circulatory support. By multivariate regression analysis we identified three independent predictors of LV systolic dysfunction age Odds ratio OR 1.11 95 confidence interval CI 1.01 to 1.22 aortic clamping time OR 1.04 95 CI 1.00 to 1.08 and Vp OR 0.65 95 CI 0.52 to 0.81 . Among echocardiographic measurements Vp was found to be superior in terms of prognostic value and reliability. The best cut-off value for Vp to predict LV dysfunction was 40 cm s
