Effect of pulse pressure on the predictability of stroke volume variation for fluid responsiveness in patients with coronary disease

Abstract

PurposeWe hypothesized that the predictability of stroke volume variation (SVV) on fluid responsiveness would be reduced in patients with coronary disease who have wide pulse pressure (PP). MethodsSixty-six patients undergoing coronary surgery were divided into 2 groups according to the PP measured 1 day before surgery: normal PP (n = 33, PP ≤ 60 mm Hg) or wide PP (n = 33, PP > 60 mm Hg). After applying mechanical ventilation, hemodynamic parameters (including SVV measured by the FloTrac/Vigileo system [Edwards Lifesciences, Irvine, Calif]) were recorded before and 10 minutes after fluid replacement in a closed-chest condition. Prediction of fluid responsiveness was tested by calculating the area under the receiver operating characteristic curves. ResultsTwenty-one patients in the normal PP and 16 patients in the wide PP condition were fluid responders. The area under the receiver operating characteristic curves of SVV to predict fluid responsiveness were 0.808 (P = .022) and 0.609 (P = .288) in the normal PP and wide PP patients, respectively. In the normal PP condition, a SVV value of 13% discriminated between fluid responders and nonresponders with a sensitivity of 76% and a specificity of 67%. ConclusionsIn contrast to patients with normal PP, SVV does not predict fluid responsiveness in patients with coronary disease who have wide PP.