Effect of Neuraxial Anaesthesia on Left Ventricular Diastolic Function Assessed by Transthoracic Echocardiography

Vol 2 | Issue 2 | July-December 2021 | Page 131-136 | Maithriye Kavishree, Srinath Damodaran, Sharanu Patil, Kumar Belani, Muralidhar Kanchi

DOI: 10.13107/ijra.2021.v02i02.041

Authors: Maithriye Kavishree [1], Srinath Damodaran [1], Sharanu Patil [2], Kumar Belani [3], Muralidhar Kanchi [1]

[1] Department of Cardiac Anaesthesia, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India.
[2] Department of Anaesthesia and Intensive care, Sparsh Hospital, Bangalore, Karnataka, India.
[3] Department of Cardiac Anaesthesia, Masonic Children’s Hospital, University of Minnesota, Minneapolis, United States of America.

Address of Correspondence
Dr. Muralidhar Kanchi
Academic Director, Senior Consultant & Professor, Department of Cardiac Anaesthesia, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India.


Purpose: To evaluate the effect of neuraxial anaesthesia on left ventricular (LV) diastolic function in clinical setting using transthoracic echocardiography (TTE).
Methods: This prospective observational study was performed in 50 adult patients undergoing elective orthopaedic surgical procedures under neuraxial anaesthesia for lower limb surgery. TTE was performed before, 20, 40 and 60 minutes after neuraxial anaesthesia. Pulsed wave Doppler of the transmitral flow (TMF), pulmonary venous flow (PVF), deceleration time (DT) and propagation velocity (Vp) were measured. Septal and lateral wall mitral annular velocities (E’, A’) were assessed by tissue Doppler imaging (TDI). The maximum diameter of left atrium (LA) and right atrium (RA), LA volume index, left ventricular (LV) and right ventricular (RV) end-diastolic area (EDA), end-systolic area (ESA), fractional area change (FAC),LV end-diastolic volume (EDV), end-systolic volume (ESV), were measured from apical 4-chamber view (A4CV) view.
Results: There were 50 patients in the cohort of whom 48 had normal diastolic function preoperatively. Following neuraxial anaesthesia, mean arterial pressure decreased (96.61.52 to 83.70.3, p <0.001) while heart rate remained unchanged (84.416.6 to 85.315.0, p =0.436). The dimensions and volumes of cardiac chambers, LV FAC and RV FAC transmitral pulse wave Doppler, DT, Vp, PVF and mitral annular TDI did not vary after neuraxial anaesthesia (p>0.05).
Conclusion: In patients with normal diastolic function, neuraxial anaesthesia does not alter diastolic function indices and grading. “It is recommended that the study be performed in patients with documented diastolic dysfunction to demonstrate beneficial or detrimental effects of central neuraxial blockade, if any.”
Keywords: Spinal anaesthesia, Neuraxial anaesthesia, Transthoracic echocardiography, Diastolic function, Left ventricle


1. Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: Appreciating the scope of the epidemic. JAMA 2003;289:194-202.
2. Groban L. Diastolic dysfunction in the elderly. J Cardiothorac Vasc Anesth 2005;19:228-36.
3. Bolliger, K. and A.M. Sadar, Care and management of the patient with right heart failure secondary to diastolic dysfunction: an advanced practice perspective and case review. Crit Care Nurs Q, 2003. 26: p. 22-7.
4. Bouthoorn, S., et al., The prevalence of left ventricular diastolic dysfunction and heart failure with preserved ejection fraction in men and women with type 2 diabetes: A systematic review and meta-analysis. Diab Vasc Dis Res, 2018. 15(6): p. 477-493.
5. Dubi, S. and Y. Arbel, Large animal models for diastolic dysfunction and diastolic heart failure-a review of the literature. Cardiovasc Pathol, 2010. 19: p. 147-52.
6. Bastos, M.G., et al., Diastolic dysfunction for nephrologists: diagnosis at the point of care. Rev Assoc Med Bras (1992), 2020. 66: p. 1750-1756.
7. Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis and measurements of diastolic function. Circulation 2002;105:1387-93.
8. Capdevila X, Macaire P, Dadure C, Choquet O, Biboulet P, Ryckwaert Y, D’Athis F. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: new landmarks, technical guidelines, and clinical evaluation. Anesth Analg. 2002;94:1606-13.
9. Berk MR, Xie GY, Kwan OL, Knapp C, Evans J, Kotchen T, et al. Reduction of left ventricular preload by lower body negative pressures alters Doppler transmitral filling patterns. J Am Coll Cardiol 1990;16:1387-92.
10. Sethi, S., V.K. Arya, and S. Chauhan, Post-extubation pulmonary edema after open cholecystectomy: significance of diastolic cardiac dysfunction. Ann Card Anaesth, 2011. 14: p. 156-8.
11. Gandhi SK, Powers JC, Nomeir AM, Fowle K, Kitzman DW, Rankin KM, et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med 2001;344:17-22.
12. Couture P, Denault AY, Shi Y, Deschamps A, Cossette M, Pellerin M, Tardif JC. Effects of anesthetic induction in patients with diastolic dysfunction. Can J Anaesth 2009;56:357–65.
13. Gare M, Parail A, Milosavljevic D, Kersten JR, Warltier DC, Pagel PS. Conscious sedation with midazolam or propofol does not alter left ventricular diastolic performance in patients with preexisting diastolic dysfunction: A transmitral and tissue Doppler transthoracic echocardiography study. Anesth Analg 93:865-871, 2001.
14. Nagueh SF, Smiseth OA, Appleton CP, et al.: “Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging”. J Am Soc Echocardiogr 2016; 29: 277-314.
15. Kaw, R., et al., Effect of diastolic dysfunction on postoperative outcomes after cardiovascular surgery: A systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2016. 152: p. 1142-53.
16. Higashi M, Yamaura K, Ikeda M, Shimauchi T, Saiki H, Hoka S: Diastolic dysfunction of the left ventricle is associated with pulmonary edema after renal transplantation. Acta Anaesthesiol Scand 2013; 57:1154–60.
17. Reyes BJ, Hallak O, Elhabyan AK, Lucas BD Jr, Kasem H: Angina with “normal” coronary arteries. JAMA 2005; 293:2468–9; author reply 2469.
18. Cutarelli R, Levy MN: Intraventricular pressure and the distribution of coronary blood flow. Circ Res 1963; 12:322–7.
19. Nishimura RA, Tajik AJ: Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s rosetta stone. J Am Coll Cardiol 1997;30:8–18.
20. Nagueh SF, Appleton CP, Gillebert TC, et al: Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 2009; 10:165–93.
21. Delgado, V. and J.J. Bax, Diastolic dysfunction and atrial fibrillation. Heart, 2015. 101(16): p. 1263-4.
22. Matyal R, Hess PE, Subramaniam B, et al: Perioperative diastolic dysfunction during vascular surgery and its association with postoperative outcome. J Vasc Surg 2009; 50:70–6.
23. Flu WJ, van Kuijk JP, Hoeks SE, et al: Prognostic implications of asymptomatic left ventricular dysfunction in patients undergoing vascular surgery. Anesthesiology 2010;112:1316.
24. Sharma R, Pellerin D, Gaze DC, Mehta RL, Gregson H, Streather CP, et al. Mitral peak Doppler E-wave to peak mitral annulus velocity ratio is an accurate estimate of left ventricular filling pressure and predicts mortality in end-stage renal disease. J Am Soc Echocardiogr. 2006; 19: 266-73.
25.Lee E, Yun S, Chin J, Choi D, Son H, Kim W, et al. Prognostic implications of preoperative E/e’ ratio in patients with off-pump coronary artery surgery. Anesthesiology. 2012; 116: 362-71.
26. Cho D, Park S, Kim M, Kim SA, Lim H, Shim W. Presence of preoperative diastolic dysfunction predicts postoperative pulmonary edema and cardiovascular complications in patients undergoing noncardiac surgery. Echocardiography. 2014; 31: 42-9.
27. Saito S, Takagi A, Kurokawa F, Ashihara K, Hagiwara N. Usefulness of tissue Doppler echocardiography to predict perioperative cardiac events in patients undergoing noncardiac surgery. Heart Vessels. 2012; 27: 594-602.
28. Hung KC, Huang HL, Chu CM, et al. Evaluating preload dependence of a novel Doppler application in assessment of left ventricular diastolic function during hemodialysis. Am J Kidney Dis 2004; 43: 1040–6.
29. Abali G, Tokgozoglu L, Ozcebe OI, Aytemir K, Nazli N. Which Doppler parameters are load independent? A study in normal volunteers after blood donation. J Am Soc Echocardiogr 2005;18:1260–65.
30. Ferré F, Delmas C, Carrié D, Cognet T, Lairez O, Minville V. Effects of spinal anaesthesia on left ventricular function: an observational study using two-dimensional strain echocardiography. Turk J Anaesth Reanim. 2018;46:268–71.
31. Cabrera Schulmeyer MC, Vargas J, la Maza De J, Labbé M. Spinal anesthesia may diminish left ventricular function: a study by means of intraoperative transthoracic echocardiography. Rev Esp Anestesiol Reanim. 2010;57:136–40.

How to Cite this Article: Kavishree M, Damodaran S, Patil S, Belani K, Kanchi M | Effect of Neuraxial Anaesthesia On Left Ventricular Diastolic Function Assessed By Transthoracic Echocardiography | July-December 2021; 2(2): 131-136.

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