The Impact of Spinal Anesthesia on Cardiac Function in Euvolemic Vascular Surgery Patients: Insights from Echocardiography and Biomarkers

Abstract Objectives: Existing evidence of the effect of spinal anesthesia on cardiac systolic function is scarce and inconclusive. This study aimed to evaluate the effects induced by a single injection of low-dose SA for elective vascular surgery on left (LV) and right (RV) ventricular systolic performance using transthoracic echocardiography (TTE). Design: A prospective study Setting: Single-center study, university hospital Participants: Adult patients undergoing elective vascular surgery with SA. Interventions: During patients’ evaluations fluid administration was targeted using arterial waveform monitoring. All patients underwent TTE studies before and after SA for the assessment of indices reflective of LV and RV systolic function. Blood samples were drawn to measure troponin and brain natriuretic peptide (BNP) levels. Measurements and Main Results: A total of 62 patients (88.7% males, 71.00±9.42 years) were included in the study. In total population, LV ejection fraction (LVEF) significantly increased after SA 53.07% [16.51]vs 53.86% [13.28]; p<0.001). End-systolic volume (ESV, 69.50 [51.50] vs 65.00 [29.50] ml; p<0.001) decreased while SV insignificantly increased (70.51±16.70 vs 73.00±18.76 ml; p=0.131) during SA. Tricuspid annular plane systolic excursion (TAPSE) remained unchanged (2.23 [0.56] vs 2.25 [0.69] mm; p=0.558). In patients with impaired compared to those with preserved LV systolic function, the changes evidenced in LVEF (7.49±4.15 vs 0.59±2.79; p<0.001), ESV (-18.13±18.20 vs-1.53±9.09; p<0.001) and SV (8.71±11.96 vs-1.43±11.89; p=0.002) were greater. Conclusions: This study provides evidence that SA in euvolemic patients undergoing elective vascular surgery improved LV systolic function, while changes in RV systolic function are minimal.