A COMPARISON OF LEFT-VENTRICULAR PERFORMANCE INDEXES MEASURED BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY WITH AUTOMATED BORDER DETECTION

Background: Automated border detection (ABD) allows semiautomated meas urement of left ventricular (LV) areas. They can be combined with left ventricular pressure signals to generate pressure-area loops and pres sure-dimension indices of contractility. This study compared conventio nal indices of ventricular performance (fractional area change [FAC] a nd circumferential fiber shortening [Vcf(c)]) with pressure-dimension indices of contractility. A secondary aim was to compare the effects o f volatile anesthetics on the indices. Methods: Using transesophageal echocardiography with automated border detection, FAC and Vcf(c) were obtained in 23 patients after cardiopulmonary bypass. Left ventricular pressures were obtained with a left ventricular catheter. Preload red uction by inferior vena caval occlusion was used to obtain end-systoli c elastance (Ees), preload recruitable stroke force (PRSF), and dP/dt( max.)EDA(-1) (EDA = end-diastolic area). In 11 patients, the measureme nts were repeated at 1 end-tidal minimum alveolar concentration of hal othane or isoflurane. The results are expressed as mean +/- SD. Result s: After cardiopulmonary bypass, FAC was 31.1 +/- 7.9%, Vcf(c) was 0.6 +/- 0.2 circ.s(-1), Ees was 25.8 +/- 11.6 mmHg.cm(-2), PRSF was 60.8 +/- 26.6 mmHg, and dP/dt(max).EDA(-1) was 245 +/- 123.4 mmHg.s(-1) cm( -2). At 1 minimum alveolar concentration of a volatile anesthetic agen t, FAG, Vcf(c), and dP/dt(max).EDA(-1) remained unchanged. Significant decreases in Ees (19%) and PRSF (28%) were observed. Conclusions: The association between pressure-dimension indices and Vcf(c) or FAC was weak or nonexistent. A reduction in myocardial contractility induced b y the administration of volatile anesthetic agents was detected by Ees and PRSF, but not by FAG, Vcf(c), or dP/dt(max) .EDA(-1). After myoca rdial revascularization, Ees and PRSF appear more sensitive than FAC o r Vcf(c) for measuring changes in contractility.