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

Purpose: The ability of the global end-diastolic volume index (GEDVI) and respiratory variations in left ventricular outflow tract velocity (Delta VTILVOT) for prediction of fluid responsiveness is still under debate. The aim of the present study was to challenge the predictive power of GEDVI and Delta VTILVOT compared with pulse pressure variation (PPV) and stroke volume variation (SVV) in a large patient population. Material and Methods: Ninety-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% (Delta SVITPTD >15%) during passive leg raising. Results: Central venous pressure showed no significant correlation with Delta SVITPTD (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 Delta VTILVOT (r = 0.54, P < .0001). The best area under the receiver operating characteristic curve (AUC) predicting Delta SVITPTD greater than 15% was found for PPV (AUC, 0.82; P < .0001) and SVV (AUC, 0.77; P < .0001), followed by Delta VTILVOT (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). Conclusions: In contrast to CVP, GEDVI and Delta VTILVOT reliably predicted fluid responsiveness under closed-chest conditions. Pulse pressure variation and SVV showed the highest accuracy. (C) 2012 Elsevier Inc. All rights reserved.