Variation of left ventricular outflow tract velocity and global end-diastolic volume index reliably predict fluid responsiveness in cardiac surgery patients

PurposeThe ability of the global end-diastolic volume index (GEDVI) and respiratory variations in left ventricular outflow tract velocity (ΔVTILVOT) for prediction of fluid responsiveness is still under debate. The aim of the present study was to challenge the predictive power of GEDVI and ΔVTILVOT compared with pulse pressure variation (PPV) and stroke volume variation (SVV) in a large patient population.Material and MethodsNinety-two patients were studied before coronary artery surgery. Each patient was monitored with central venous pressure (CVP), the PiCCO system (Pulsion Medical Systems, Munich, Germany), and transesophageal echocardiography. Responders were defined as those who increased their stroke volume index by greater than 15% (ΔSVITPTD >15%) during passive leg raising.ResultsCentral venous pressure showed no significant correlation with ΔSVITPTD (r = −0.06, P = .58), in contrast to PPV (r = 0.71, P < .0001), SVV (r = 0.61, P < .0001), GEDVI (r = −0.54, P < .0001), and ΔVTILVOT (r = 0.54, P < .0001). The best area under the receiver operating characteristic curve (AUC) predicting ΔSVITPTD greater than 15% was found for PPV (AUC, 0.82; P < .0001) and SVV (AUC, 0.77; P < .0001), followed by ΔVTILVOT (AUC, 0.74; P < .0001) and GEDVI (AUC, 0.71; P = .0006), whereas CVP was not able to predict fluid responsiveness (AUC, 0.58; P = .18).ConclusionsIn contrast to CVP, GEDVI and ΔVTILVOT reliably predicted fluid responsiveness under closed-chest conditions. Pulse pressure variation and SVV showed the highest accuracy.