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BJA Advance Access published online on July 11, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael140
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted March 16, 2006

Clinical Investigation

Left ventricular end-diastolic pressure is a predictor of mortality in cardiac surgery independently of left ventricular ejection fraction

R. Salem 1, A. Y. Denault 1 *, P. Couture 1, S. Bélisle 1, A. Fortier 2, M.-C. Guertin 2, M. Carrier 3, and R. Martineau 1

1 Department of Anesthesiology, Montreal Heart Institute, Montreal, Quebec, H1T 1C8, Canada
2 Department of Biostatistics, Montreal Heart Institute, Montreal, Quebec, H1T 1C8, Canada
3 Department of Surgery, Montreal Heart Institute, Montreal, Quebec, H1T 1C8, Canada

* To whom correspondence should be addressed.
A. Y. Denault, E-mail: denault{at}videotron.ca


  Abstract

Background. Several risk factors have been shown to increase mortality in cardiac surgery. However, the importance of left ventricular end-diastolic pressure (LVEDP) as an independent risk factor before cardiac surgery is unclear.

Method. This observational study investigated 3024 consecutive adult patients who underwent cardiac surgical procedures at the Montreal Heart Institute from 1996 to 2000. The primary outcome was in-hospital mortality with 99 deaths (3.3%) among these patients.

Results. Of the 35 variables subjected to univariate analysis, 23 demonstrated a significant association with mortality. Stepwise multivariate logistic regression identified LVEDP as an independent predictor of mortality after cardiac surgery. The area under the receiver operating characteristic curve of the model predicting mortality was 0.85.

Conclusions. Elevated LVEDP is an independent predictor of mortality in cardiac surgery. This variable is independent of left ventricular ejection fraction.

Keywords: cardiovascular system, effects; complications; risk; surgery, cardiovascular.
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