Preoperative echocardiography as a predictor of spinal anesthesia-induced hypotension in older patients with mild left ventricular diastolic dysfunction: a retrospective observational study

Abstract

Background: Spinal anesthesia-induced hypotension (SAH) frequently occurs in older pa-tients, many of whom have mild left ventricular (LV) diastolic dysfunction, often asymptomat-ic at rest. This study investigated the association between preoperative echocardiographic measurements and SAH in older patients with mild LV diastolic dysfunction. Methods: We conducted a retrospective observational study using data from electronic medical records. The patients ≥ 65 years old who underwent spinal anesthesia for urologic surgery between January 2016 and December 2017 and whose preoperative echocardiog-raphy within 6 months before surgery revealed grade I LV diastolic dysfunction were recruit-ed. SAH was investigated using the anesthesia records. Logistic regression and receiver op-erating characteristic (ROC) curve analyses were performed. Results: A total of 163 patients were analyzed. SAH and significant SAH developed in 55 (33.7%) patients. The mitral inflow E velocity was an independent risk factor for SAH (odds ratio [OR], 0.886; 95% confidence interval [CI], 0.845–0.929; P < 0.001). The area under the ROC curve for mitral inflow E velocity to predict SAH was 0.819 (95% CI, 0.752–0.875; P < 0.001). If mitral inflow E velocity was ≤ 60 cm/s, SAH was predicted with a sensitivity of 83.6% and specificity of 70.4%. Conclusions: The preoperative mitral inflow E velocity demonstrated the greatest predict-ability of SAH in older patients with mild LV diastolic dysfunction. This may assist in identify-ing patients at high risk of SAH and guiding preventive strategies in the future.