Sevoflurane Effect on Left Atrial Performance: A Transoesophageal Echocardiographic Study

Completed

• Conditions: Ischemic Heart Disease

• Registration Number: NCT03999463
• Lead Sponsor: Ain Shams University

Brief Summary

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

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 Timeline

• Study First Submitted: 2019-06-23
• Study First Submitted QC: 2019-06-25
• Study First Posted: 2019-06-26
• Study Start: 2019-07-01
• Primary Completion: 2019-09-30
• Status Verified: 2019-12
• Study Completion: 2019-12-31
• Last Update Submitted: 2019-12-31
• Last Update Posted: 2020-01-03

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 30

Inclusion Criteria

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

Read More

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

Read More

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
intraoperative transoesophageal echocardiography to test the effect of Sevoflurane on left atrial performance	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)).	Mitral inflow early diastolic velocity (meter/second)(m/s)

Trial Locations

Locations (1)

Ain-Shams University Hospitals; 🇪🇬 Cairo, Egypt