Sevoflurane Effect on Left Atrial Performance: A Transoesophageal Echocardiographic Study

Sevoflurane Effect on Left Atrial Performance: A Transoesophageal Echocardiographic Study on Patients Undergoing Coronary Artery Bypasses Grafting

The left atrial performance is affected by the preload as well as the afterload. The LA active pumping is increased by stretching of the LA but within limits, after which the active pumping declines. The LV stiffness acts as the LA afterload. Whenever the LV stiffness increases, the overall emptying fraction becomes more pumpdependent

Study Overview

• Status: Completed
• Conditions: Ischemic Heart Disease

Detailed Description

The echocardiographic assessment of the LA was frequently overlooked. While left atrial performance reflects both systolic and diastolic functions of the LV, it looks like more studies are being conducted to detect the effect of different interventions on the left atrial size and function. Other studies focus on the prognostic value and the ability to risk stratify different cohorts of patients, based on the early recognition of deranged LA performance.

Many studies were conducted on the effect of inhalational anesthetics on the left atrial function. Yet the results are inconclusive and sometimes contradictory. In a study on dogs, Gare Meir and his colleagues proved that desflurane, sevoflurane, and isoflurane depress left atrial contractility, delay relaxation, reduce chamber stiffness, preserve reservoir and conduit function, and impair left atrial-left ventricular coupling in vivo. Volatile anesthetics may cause impairment of both left atrial (LA) and left ventricular (LV) contractility. The mechanisms suggested were a decrease in the influx of calcium via voltage gated calcium channels as well as a decrease in calcium availability from sarcoplasmic reticulum.Echocardiographic assessment of the LA volumetric measures is comparable to that of Cardiovascular Magnetic Resonance (CMR) with clinically irrelevant difference. This makes echocardiographic assessment of LA volumes reliable, cheaperand easier to obtain.

• Study Type: Observational
• Enrollment (Actual): 30

Contacts and Locations

Study Locations

• Egypt
  • Cairo, Egypt, 11361
    • Ain-Shams University Hospitals

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

adult patients of any sex,40-75 years, maintaining sinus rhythm undergoing elective with preserved left ventricular systolic function.

Description

Inclusion Criteria:

• Clinical diagnosis of ischemic heart disease
• Elective coronary artery bypass grafting.

Exclusion Criteria:

• Atrial or ventricular dysrhythmias,
• Associated mitral valve disease,
• Ejection Fraction <40%,
• Emergency coronary artery bypass grafting,
• Pericardial disease
• Contraindication to perform a TEE, e.g. Esophageal tumor

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
intraoperative transoesophageal echocardiography to test the effect of Sevoflurane on left atrial performance	Mitral inflow early diastolic velocity (meter/second)(m/s)	30 Minutes (Start point: After induction of anesthesia and before starting sevoflurane (first set of data). End point: After achieving one MAC sevoflurane anesthesia and before skin incision (second set of data)).

Collaborators and Investigators

• Sponsor: Ain Shams University

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2019
• Primary Completion (Actual): September 30, 2019
• Study Completion (Actual): December 31, 2019

Study Registration Dates

• First Submitted: June 23, 2019
• First Submitted That Met QC Criteria: June 25, 2019
• First Posted (Actual): June 26, 2019

Study Record Updates

• Last Update Posted (Actual): January 3, 2020
• Last Update Submitted That Met QC Criteria: December 31, 2019
• Last Verified: December 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Coronary Disease; Heart Diseases; Coronary Artery Disease; Myocardial Ischemia
• Other Study ID Numbers: R 35 / 2019

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No