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J Thorac Cardiovasc Surg 2006;131:1080-1086
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Biventricular diastolic filling patterns after coronary artery bypass graft surgery

Yanfen Shi, MD c , André Y. Denault, MD a , Pierre Couture, MD a , Ady Butnaru, MD c , Michel Carrier, MD b , Jean-Claude Tardif, MD, FACC c , *

a Department of Anesthesia, Montreal Heart Institute, and University of Montreal, Montreal, Quebec, Canada
b Department of Surgery, Montreal Heart Institute, and University of Montreal, Montreal, Quebec, Canada
c Department of Medicine, Montreal Heart Institute, and University of Montreal, Montreal, Quebec, Canada

Received for publication September 27, 2005; revisions received January 10, 2006; accepted for publication January 13, 2006.

* Address for reprints: Jean-Claude Tardif, MD, Montreal Heart Institute, 5000 Belanger St, Montreal, QC H1T 1C8, Canada (Email: jean-claude.tardif{at}icm-mhi.org).

OBJECTIVE: We sought to study the evolution of biventricular filling properties after coronary artery bypass grafting.

BACKGROUND: The evolution of diastolic function as defined with newer echocardiographic modalities after coronary artery bypass grafting surgery is unknown in patients with preoperative left ventricular diastolic dysfunction.

METHODS: Transthoracic echocardiography was performed preoperatively and 48 hours and 6 months after coronary artery bypass grafting in 49 patients (randomized to milrinone [n = 25]) or placebo [n = 24]) with preoperative left ventricular diastolic dysfunction classified according to published criteria. Mild right ventricular diastolic dysfunction was defined as the ratio of early to atrial filling velocity of less than 1 in transtricuspid flow or the velocity of reversed atrial flow of greater than 50% of that of systolic flow in hepatic venous flow or the ratio of tricuspid annulus velocity during early and atrial filling of less than 1 if both the ratio of early to atrial filling velocity and the ratio of systolic to diastolic velocity was greater than 1 in hepatic venous flow. Moderate right ventricular diastolic dysfunction was diagnosed when there was a ratio of early to atrial filling velocity of greater than 1 with a ratio of systolic to diastolic velocity of less than 1. Severe right ventricular diastolic dysfunction was defined as a ratio of early to atrial filling velocity of greater than 1 associated with reversed systolic wave in hepatic venous flow.

RESULTS: Moderate and severe left ventricular diastolic dysfunction increased from preoperatively to 48 hours after coronary artery bypass grafting from 8.2% to 53.7% and from 2.0% to 9.7%, respectively (P < .0001, 48 hours vs preoperatively for both), and the patterns at 6 months were similar to those observed preoperatively. Similar evolution over time was found for right ventricular diastolic dysfunction.

CONCLUSIONS: In patients with preoperative left ventricular diastolic dysfunction, biventricular filling patterns are impaired initially but return to preoperative status 6 months after coronary artery bypass grafting.

Abbreviations and Acronyms A = atrial filling A-wave velocity; Am = late mitral annular velocity; Ar = reversed atrial flow; At = atrial filling tricuspid annular velocity; CABG = coronary artery bypass grafting; CPB = cardiopulmonary bypass; D = diastolic D-wave velocity; DT = E-wave deceleration time; E = early mitral filling E-wave velocity; Em = early mitral annular velocity; Et = early filling tricuspid annular velocity; HVF = hepatic venous flow; IVRT = isovolumic relaxation time; LVDD = left ventricular diastolic dysfunction; LVEF = left ventricular ejection fraction; PVF = pulmonary venous flow; PW = pulsed wave; RVDD = right ventricular diastolic dysfunction; S = systolic S-wave velocity; TDI = tissue Doppler imaging; TMF = transmitral flow; TTF = transtricuspid flow; Vp = propagation velocity




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