Key result
The preoperative dIVCmax-to-IVCCI ratio < 48 demonstrated high diagnostic power (AUC 0.9) in predicting post-spinal anesthesia hypotension in elderly patients with left ventricular dysfunction.
Why the study?
In elderly patients with cardiac diseases, diminished cardiovascular reserve predisposes to post-spinal anesthesia hemodynamic instability, but the diagnostic power of preoperative echocardiography to predict this hypotension was unclear.
Does the preoperative dIVCmax-to-IVCCI ratio predict post-spinal anesthesia hypotension in elderly patients with cardiac diseases and reduced LV-EF?
Cohort (n=61)
Single-blind
No
Does the preoperative dIVCmax-to-IVCCI ratio predict post-spinal anesthesia hypotension in elderly patients with cardiac diseases and reduced LV-EF?
Effect estimate: AUC 0.9 (95% CI 0.8-0.96)
p-value: p=<0.05
The preoperative dIVCmax-to-IVCCI ratio is a highly reliable echocardiographic index for predicting post-spinal anesthesia hypotension in elderly patients with left ventricular dysfunction.
May aid preoperative risk stratification in elderly cardiac patients; leaves open whether TTE use improves outcomes.
In elderly patients with cardiac diseases, changes in cardiovascular physiology diminish cardiovascular reserve and predispose to hemodynamic instability after spinal anesthesia; hence, such patients could be at risk of postoperative complications. Additionally, transthoracic echocardiography (TTE) is used in clinical practice to evaluate cardiovascular hemodynamics. Therefore, we hypothesized that echocardiographic measurements could display significant diagnostic power in the prediction of post - spinal anesthesia hypotension in elderly patients with cardiac diseases and reduced left ventricular ejection fraction (LV-EF). Therefore, sixty-one elderly orthopedic-trauma patients were recruited. Prior to spinal anesthesia a TTE examination was performed. The LV-EF, the stroke volume index (SVI), the peripheral vascular resistance (PVR), the LV filling pressures (E/Em ratio), the right ventricular function [tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (TASV) and fractional area change (FAC)], as well as inferior vena cava (IVC) measurements, such as IVCCI (collapsibility index of the IVC) and dIVCmax (maximum diameter of IVC)-to-IVCCI ratio were assessed. Twenty-six out of sixty-one patients manifested hypotension. Preoperative dIVCmax-to-IVCCI ratio demonstrated the greatest performance amongst echocardiographic indices in predicting post - spinal anesthesia hypotension. The dIVCmax-to-IVCCI ratio < 48 had significantly higher diagnostic power than IVCCI > 0.28, FAC > 42, E/Em ratio < 9 and SVI < 32 (receiver operator characteristic curve analysis). The gray zone for the dIVCmax-to-IVCCI ratio (40-49) showed the lowest number of inconclusive measurements among echocardiographic variables. The preoperative dIVCmax-to-IVCCI ratio could be a reliable echocardiographic index to predict post - spinal anesthesia hypotension in elderly patients with left ventricular dysfunction.
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Moschovaki et al. (2023) conducted a cohort in Post-spinal anesthesia hypotension in cardiac disease with left ventricular dysfunction (n=61). Preoperative dIVCmax-to-IVCCI ratio vs. Other echocardiographic indices (IVCCI, FAC, E/Em ratio, SVI) was evaluated on Prediction of post-spinal anesthesia hypotension (AUC 0.9, 95% CI 0.8-0.96, p=<0.05). The preoperative dIVCmax-to-IVCCI ratio < 48 demonstrated high diagnostic power (AUC 0.9) in predicting post-spinal anesthesia hypotension in elderly patients with left ventricular dysfunction.
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