The Utility of Echocardiography for the Prediction of Spinal-Induced Hypotension in Elderly Patients: Inferior Vena Cava Assessment Is a Key Player.

Abstract

OBJECTIVES\nTo prospectively assess the diagnostic performance of echocardiographic measurements before spinal anesthesia in elderly patients undergoing lower limb surgery. Emphasis was placed on the dIVCmax-to-IVCCI ratio and IVCCI, where dIVCmax was the maximum diameter of inferior vena cava (IVC) at expiration and IVCCI was the collapsibility index of IVC.\n\n\nDESIGN\nOpen cohort, prospective, single-center study.\n\n\nSETTING\nUniversity hospital.\n\n\nINTERVENTIONS\nA transthoracic echocardiography examination was performed in 70 patients before spinal anesthesia under standard criteria and protocol. Patients with intraoperative mean arterial pressure ≤65 mmHg or ≥25% reduction of its preoperative baseline were considered hypotensive.\n\n\nMEASUREMENTS AND MAIN RESULTS\nPreoperative echocardiographic measurements, including IVCCI, dIVCmax-to-IVCCI, ejection fraction, global longitudinal peak systolic strain, tricuspid annular plane systolic excursion, ratio of peak velocity flow in early diastole and average of peak velocities in early diastole of lateral and septal mitral annulus, stroke volume index, and left ventricle mass index were assessed. Twenty-eight of 70 patients manifested spinal-induced hypotension. Preoperative dIVCmax-to-IVCCI showed the greatest diagnostic performance among the indices. dIVCmax-to-IVCCI <43 had significantly higher diagnostic power than did IVCCI >0.3 (p\u202f=\u202f0.032). Multiple logistic regression analysis revealed that the best predictors for spinal-induced hypotension were the dIVCmax-to-IVCCI ratio and age.\n\n\nCONCLUSIONS\nThe preoperative dIVCmax-to-IVCCI ratio can predict spinal-induced hypotension greater than IVCCI and other echocardiographic measurements in elderly patients. Both dIVCmax-to-IVCCI ratio and patient age can act as predictors of spinal-induced hypotension in elderly patients.