Document Detail

High thoracic epidural analgesia improves left ventricular function in patients with ischemic heart.
MedLine Citation:
PMID:  19419349     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In patients with ischemic heart disease, high thoracic epidural analgesia (HTEA) has been proposed to improve myocardial function. Tissue Doppler Imaging (TDI) is a tool for quantitative determination of myocardial systolic and diastolic velocities and a derivative of TDI is tissue tracking (TT), which allows quantitative assessment of myocardial systolic longitudinal displacement during systole. The purpose of this study was to evaluate the effect of thoracic epidural analgesia on left ventricular (LV) systolic and diastolic function by means of two-dimensional (2D) echocardiography and TDI in patients with ischemic heart disease. METHODS: The effect of a high epidural block (at least Th1-Th5) on myocardial function in patients (N=15) with ischemic heart disease was evaluated. Simpson's 2D volumetric method was used to quantify LV volume and ejection fraction. Systolic longitudinal displacement was assessed by the TT score index and the diastolic function was evaluated from changes in early (E'') and atrial (A'') peak velocities during diastole. RESULTS: After HTEA, 2D measures of left ventricle function improved significantly together with the mean TT score index [from 5.87 +/- 1.53 to 6.86 +/- 1.38 (P<0.0003)], reflecting an increase in LV global systolic function and longitudinal systolic displacement. The E''/A'' ratio increased from 0.75 +/- 0.27 to 1.09 +/- 0.32 (P=0.0026), indicating improved relaxation. CONCLUSION: A 2D-echocardiography in combination with TDI indicates both improved systolic and diastolic function after HTEA in patients with ischemic heart disease.
C-J Jakobsen; E Nygaard; K Norrild; H Kirkegaard; J Nielsen; P Torp; E Sloth
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  53     ISSN:  1399-6576     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-07     Completed Date:  2009-07-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  England    
Other Details:
Languages:  eng     Pagination:  559-64     Citation Subset:  IM    
Department of Anaesthesia & Intensive Care, Aarhus University Hospital, Skejby, Aarhus, Denmark.
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MeSH Terms
Analgesia, Epidural*
Anesthetics, Local / administration & dosage,  therapeutic use
Middle Aged
Myocardial Ischemia / drug therapy*,  physiopathology*,  ultrasonography
Thoracic Vertebrae
Ventricular Function, Left / physiology*
Reg. No./Substance:
0/Anesthetics, Local

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