The assessment of diastolic function using trans-mitral Doppler and tissue Doppler
imaging during coronary artery bypass surgery (CABG) is complex, with anaesthesia,
blood loss and ischaemia all contributing to altered loading conditions. Ten patients
undergoing coronary artery bypass grafting underwent simultaneous transoesophageal
and pressure volume loop analysis of diastolic function at different loading conditions
(baseline, preload reduction, afterload increase, increased heart rate and post cardiopulmonary
bypass). The mean age was 59 ± 9 years and 3 (range 2–5) grafts. Altered loading conditions resulted in no significant
changes in Tau or the end diastolic pressure volume relationship. dP/dt min varied significantly across loading conditions (p < 0.001). Tissue Doppler peak Em measured at the lateral mitral annulus was affected
significantly with increased heart rate (p < 0.01), but was insensitive to changes in preload and afterload. Instantaneous end
diastolic stiffness (IEDS = log10 PCWP/EDA) did not alter during loading conditions (p = 0.99). Peak Em (lateral annulus) and IEDS appear promising as measures of diastolic
function over a range of haemodynamic alterations, although changes in Peak Em may
not reflect diastolic function accurately if the heart rate substantially changes.
Keywords
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Article info
Publication history
Accepted:
January 9,
2011
Received in revised form:
December 23,
2010
Received:
December 29,
2009
Identification
Copyright
© 2011 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved.
