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  • Title: Echocardiographic predictor of acute heart failure after spine surgery: a novel tissue Doppler index associated with a potentially fatal complication of the operation.
    Author: Kim TH, Mun JB, Jung E, Jeong IK, Choi S, Lee SH, Chung WJ, Ahn T, Moon J.
    Journal: Spine J; 2014 May 01; 14(5):782-8. PubMed ID: 24055613.
    Abstract:
    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 ± 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 ± 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 ± 7 vs. 64 ± 9 years), had longer anesthesia time (7.4 ± 4.2 vs. 3.6 ± 2.1 hours), and were treated with a greater volume of fluid replacement during the operation (3.8 ± 0.7 vs. 1.3 ± 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') was higher (11 vs. 8) and left atrial volume index was larger (20 ± 6 vs. 17 ± 6 mL/m(2)) 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' (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' reflecting LV filling pressure predicted postoperative HF in patients who underwent spine surgery.
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