BJA Advance Access originally published online on July 17, 2008
British Journal of Anaesthesia 2008 101(4):479-485; doi:10.1093/bja/aen212
Tei index to assess perioperative left ventricular systolic function in patients undergoing mitral valve repair
1 Department of Anaesthesiology and Critical Care
2 Department of Thoracic and Cardiovascular Surgery
3 Department of Emergency Medicine, Centre Hospitalier Universitaire (CHU) Pitié-Salpêtrière, Assistance Publique–Hôpitaux de Paris (AP-HP), UMPC Univ Paris 06, F-75013 Paris, France
4 Department of Cardiology, King's College, London, UK
* Corresponding author: Département Anesthésie Réanimation, Hôpital Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75651 Paris, Cedex 13, France. E-mail: alexandre.ouattara{at}psl.aphp.fr
Background: Using echocardiography, perioperative assessment of systolic function by fractional area change (FAC) is questionable in patients suffering from mitral regurgitation (MR). Tei index, an index expressing global cardiac function, has been reported to be unchanged after mitral valve surgery. We tested the hypothesis where the Tei index could be useful in assessing the perioperative cardiac function in patients undergoing mitral valve repair (MVR).
Methods: Twenty-five patients were enrolled. Transoesophageal echocardiography was performed perioperatively before and after the correction of MR. We compared the impact of the MVR on the left ventricular FAC and the Tei index. FAC was calculated from the transgastric short-axis view and Tei index was determined from the four chambers and deep transgastric views.
Results: Two patients were excluded because of poor acoustic windows. FAC significantly decreased after MVR from 53 (9)% to 42 (10)% (P<0.001), while Tei index was unaffected [0.46 (0.16) vs 0.47 (0.17), NS]. A significant relationship was found between the preoperative Tei index and the postoperative FAC (R=–0.64, P<0.001). Moreover, a significant and clinically relevant relationship was determined between the predicted (using preoperative Tei index) and the measured postoperative FAC (R=0.64, P<0.001).
Conclusions: FAC but not the Tei index is influenced by MVR. The preoperative determination of the Tei index allows predicting postoperative FAC and offers the opportunity to identify patients in whom a severe unsuspected systolic dysfunction could render difficult the weaning from cardiopulmonary bypass.
Keywords: heart, cardiopulmonary bypass; heart, myocardial function; monitoring, echocardiography