• Michael R Mathis, Neal M Duggal, Allison M Janda, Jordan L Fennema, Bo Yang, Francis D Pagani, Michael D Maile, Ryan E Hofer, Elizabeth S Jewell, and Milo C Engoren.
• Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI; Department of Computational Medicine and Bioinformatics, University of Michigan Health System, Ann Arbor, MI. Electronic address: mathism@med.umich.edu.
• J. Cardiothorac. Vasc. Anesth. 2021 Sep 1; 35 (9): 2732-2742.

ObjectiveDespite advances in echocardiography and hemodynamic monitoring, limited progress has been made to effectively quantify left ventricular function during cardiac surgery. Traditional measures, including left ventricular ejection fraction (LVEF) and cardiac index, remain dependent on loading conditions; more complex measures remain impractical in a dynamic surgical setting. However, the Smith-Madigan Inotropy Index (SMII) and potential-to-kinetic energy ratio (PKR) offer promise as measures calculable during cardiac surgery and potentially predictive of outcomes. Using echocardiographic and hemodynamic monitoring data, the authors aimed to calculate SMII and PKR values after cardiopulmonary bypass and understand associations with postoperative outcomes, adjusting for previously identified risk factors.DesignObservational cohort study.SettingTertiary care academic hospital.PatientsThe study comprised 189 elective adult cardiac surgical procedures from 2015-2016.InterventionNone.Measurements And Main ResultsThe primary outcome was postoperative mortality or organ system complication (stroke, prolonged ventilation, reintubation, cardiac arrest, acute kidney injury, new-onset atrial fibrillation). After adjustment, SMII <0.83 W/m2 independently predicted the primary outcome (adjusted odds ratio 2.19, 95% confidence interval 1.08-4.42); whereas PKR, LVEF, and cardiac index demonstrated no associations. When SMII and PKR were incorporated into a EuroSCORE II risk model, predictive performance improved (net reclassification index improvement 0.457; p = 0.001); whereas a model incorporating LVEF and cardiac index demonstrated no improvement (0.130; p = 0.318).ConclusionThe present study demonstrated that SMII, but not PKR, as a measure of cardiac function was associated with major complications. The study's data may guide investigations of more suitable perioperative goal-directed therapies to reduce complications after cardiac surgery.Copyright © 2021 Elsevier Inc. All rights reserved.

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