Echocardiographic predictor of acute heart failure after spine surgery: a novel tissue Doppler index associated with a potentially fatal complication of the operation

Abstract

Background contextAcute heart failure (HF) is a potentially fatal complication after spine surgery. PurposeWe sought to identify clinical and echocardiographic predictors of postoperative HF in spine surgery patients. Study designRetrospective observational study. Patient sampleA 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 measuresHeart 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. MethodsClinical, 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). ResultsPostoperative 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/m2) 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. ConclusionsAcute 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.