Validation of myocardial oxygen demand indices in patients awake and during anesthesia.

An important guideline for anesthesia in patients with ischemic heart disease is the effect on myocardial oxygen demand. Therefore, this investigation evaluated commonly used myocardial oxygen demand formulas for clinical application. The study was performed on patients undergoing coronary bypass surgery (n = 62). Measurements of standard hemodynamics were obtained before and after induction of anesthesia, as well as during sternotomy and after surgery. Coronary blood flow was determined by the argon wash-in technique. In 15 patients, a left ventricular tip manometer was used to accurately assess the first derivative of left ventricular pressure time course. The following indices of left ventricular oxygen demand were calculated: 1) rate pressure product (RPP); 2) tension time index (TTI); 3) pressure work index (PWI) according to the methods of Rooke; and 4) additive parameter (Eg), according to the methods of Bretschneider. All hemodynamic indices of myocardial oxygen demand showed moderate correlation with myocardial oxygen uptake (MVO2) (RPP: r = 0.77; TTI: r = 0.79; PWI: r = 0.79; Eg: r = 0.71). On the average, PWI and Eg led to an underestimation of MVO2 in patients. The constants of the PWI and Eg formulas, which have been developed based on animal experiments, therefore are not directly applicable to clinical conditions. New constants have been derived for PWI by multiple linear regression analysis of the data in the current investigation.(ABSTRACT TRUNCATED AT 250 WORDS)