Myocardial Performance Index Is a Predictor of Outcome After Abdominal Aortic Aneurysm Repair

Mahmood, Feroze; Matyal, Robina; Maslow, Andrew; Subramaniam, Balachundar; Mitchell, John; Panzica, Peter; Karthik, Swaminathan; Hess, Philip

doi:10.1053/j.jvca.2008.04.006

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Volume 22, Issue 5 , Pages 706-712, October 2008

Myocardial Performance Index Is a Predictor of Outcome After Abdominal Aortic Aneurysm Repair

Feroze Mahmood, MD
- Department of Anesthesia and Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Address reprint requests to Feroze Mahmood, MD, Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, CC-470 A, Deaconess 1, Boston, MA 02215
Robina Matyal, MD
- Department of Anesthesia and Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Andrew Maslow, MD
- Department of Anesthesia and Critical Care, Rhode Island Hospital, Brown University Medical School, Providence, RI
Balachundar Subramaniam, MD
- Department of Anesthesia and Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
John Mitchell, MD
- Department of Anesthesia and Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Peter Panzica, MD
- Department of Anesthesia and Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Swaminathan Karthik, MD
- Department of Anesthesia and Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Philip Hess, MD
- Department of Anesthesia and Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

published online 18 June 2008.

Objective: Perioperative measurement of the myocardial performance index (MPI) with transesophageal echocardiography in patients undergoing elective abdominal aortic aneurysm repair and its association with outcome.

Design: A prospective observational study.

Setting: A tertiary care university hospital.

Participants: Patients undergoing elective abdominal aortic aneurysm repair.

Intervention: Perioperative transesophageal echocardiography.

Measurements: Fifty-one consecutive patients undergoing elective abdominal aortic aneurysm repair were enrolled in the study. The MPI was calculated by using pulse-wave Doppler from the midesophageal window and the deep transgastric position of the probe. In addition, diastolic function was measured as the slope of the transmitral flow propagation velocity, and ejection fraction was calculated as a measure of ventricular systolic function. Comparisons between subjects with uncomplicated versus adverse outcomes were made by using a Mann-Whitney U test. Comparison of the incidence of adverse outcome among subjects with normal and elevated MPIs was made by using a Fisher exact test. Statistical significance was set at p < 0.05.

Results: It was possible to calculate MPI in all patients with transesophageal echocardiography perioperatively. Patients with adverse postoperative outcomes had an elevated MPI as compared with those without any adverse outcome (0.50 v 0.30, p < 0.001). Also, an MPI of ≥0.36 was associated with a statistically significant higher incidence of complications (congestive heart failure/prolonged intubation) (p < 0.001).

Conclusions: The MPI is an easily obtained echocardiographic measure of global ventricular performance, which can be measured perioperatively and may be useful as a prospective risk stratification index for patients undergoing elective abdominal aortic aneurysm surgery.

Key Words: abdominal aortic aneurysm, myocardial performance index, diastolic function, systolic function, outcome, transesophageal echocardiography