Y Koide1, L Keehn, T Nomura, T Long, Y Oka. 1. Department of Anesthesiology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
Abstract
BACKGROUND: It has been demonstrated that new regional wall motion abnormalities (RWMAs) are infrequently associated with electrocardiographic (ECG) ischemic changes during coronary artery bypass graft (CABG) surgery. The evaluation of apical or basal areas by biplane transesophageal echocardiography (TEE) may clarify the relationship between RWMA and ECG changes. METHODS: Biplane TEE and ECG (leads II and V5) were continuously monitored in a total of 98 patients undergoing CABG surgery to determine the incidence and characteristics of RWMAs and to relate these findings to ECG changes. RESULTS: Twenty-four new RWMAs were detected in 21 (21%) patients. Incidences of new RWMAs in each view were found to be as follows: 12 (50%) in short-axis view (SAV); 5 (21%) in long-axis view (LAV); and 7 (29%) in both views. Ten of the 24 new RWMA episodes (42%) corresponded to ECG ischemic changes. These new ECG changes were significantly more common when the new RWMAs appeared on both views (86%) as compared with the LAV alone (0%) (p < 0.01) or with SAV alone (33%). Moreover, in patients with a greater number of abnormal segments (> 3), new RWMAs were significantly (p < 0.05) associated with ECG changes. CONCLUSION: Biplane TEE provides additional information about spatial distribution of new RWMAs. This study was the first to demonstrate that a clear relationship between TEE and ECG ischemia exists. When these new RWMAs exhibited a large spatial distribution, the frequency of ECG ischemic changes increased.
BACKGROUND: It has been demonstrated that new regional wall motion abnormalities (RWMAs) are infrequently associated with electrocardiographic (ECG) ischemic changes during coronary artery bypass graft (CABG) surgery. The evaluation of apical or basal areas by biplane transesophageal echocardiography (TEE) may clarify the relationship between RWMA and ECG changes. METHODS: Biplane TEE and ECG (leads II and V5) were continuously monitored in a total of 98 patients undergoing CABG surgery to determine the incidence and characteristics of RWMAs and to relate these findings to ECG changes. RESULTS: Twenty-four new RWMAs were detected in 21 (21%) patients. Incidences of new RWMAs in each view were found to be as follows: 12 (50%) in short-axis view (SAV); 5 (21%) in long-axis view (LAV); and 7 (29%) in both views. Ten of the 24 new RWMA episodes (42%) corresponded to ECG ischemic changes. These new ECG changes were significantly more common when the new RWMAs appeared on both views (86%) as compared with the LAV alone (0%) (p < 0.01) or with SAV alone (33%). Moreover, in patients with a greater number of abnormal segments (> 3), new RWMAs were significantly (p < 0.05) associated with ECG changes. CONCLUSION: Biplane TEE provides additional information about spatial distribution of new RWMAs. This study was the first to demonstrate that a clear relationship between TEE and ECG ischemia exists. When these new RWMAs exhibited a large spatial distribution, the frequency of ECG ischemic changes increased.