Takaki A, Sugi K, Sano T, Tanaka N, Matsuzaki M
Department of Cardiology, National Sanyo Hospital, Yamaguchi.
J Cardiol. 2000 Oct;36(4):241-9.
The effects of pulmonary resection on cardiac function have not been well characterized. This study used Doppler echocardiography to evaluate preoperative and postoperative right and left ventricular function with preload augmentation by elevation of the legs.
Twenty-one patients (12 males, 9 females, mean age 64 +/- 11 years) undergoing pulmonary resection for lung cancer underwent concurrent examination of cardiac and pulmonary function at 1 week preoperation and 4 weeks postoperation. Cardiac function of right and left ventricles was assessed by Doppler echocardiography to record waveforms of transtricuspid flow and transmitral flow. Assessment was made in the supine position and with leg elevation 60 degrees to apply preload augmentation. We measured the interval between cessation and onset of transatrioventricular flow, ventricular ejection time and Tei index as an index of global ventricular function. Peak velocity of early filling (E) and atrial contraction (A) were measured from the transtricuspid and transmitral flows to calculate E/A of the right and left ventricles (ER/AR, EL/AL). Pulmonary function tests yielded the forced vital capacity expressed as the ratio to the predicted value as an index for the pulmonary vascular bed area.
The postoperative cardiac function without preload augmentation was comparable to the preoperation function. With preload augmentation, the postoperative ER/AR was less than preoperation in the patients with postoperative forced vital capacity < or = 80% of the preoperation value. There was a significant correlation between the postoperation versus preoperation ratio of ER/AR and of forced vital capacity (r = 0.66, p = 0.0028) and ratio of right ventricular Tei index and of forced vital capacity (r = 0.61, p = 0.0034). There was a possibility that right ventricular Tei index indirectly indicated the state of pulmonary vascular bed area.
The right ventricular Tei index is useful to estimate preoperation and postoperation global right ventricular function. No close relationship between ER/AR and EL/AL at preoperation (r = 0.70, p = 0.0004) was found in the patients with postoperative right ventricular Tei index > 0.1 greater than at preoperation. Pulmonary resection might affect the diastolic function of the right ventricle more than the left ventricle, possibly because of reduced compliance of the right ventricle indicated by an increased atrial contraction at postoperation with preload augmentation.
肺切除对心功能的影响尚未得到充分阐明。本研究采用多普勒超声心动图，通过抬高下肢增加前负荷，来评估术前和术后左右心室功能。
21例（12例男性，9例女性，平均年龄64±11岁）因肺癌接受肺切除的患者，在术前1周和术后4周同时进行心肺功能检查。通过多普勒超声心动图评估左右心室功能，记录三尖瓣血流和二尖瓣血流波形。评估在仰卧位以及将下肢抬高60度以增加前负荷的情况下进行。我们测量房室血流停止与开始之间的间隔、心室射血时间以及作为整体心室功能指标的Tei指数。从三尖瓣和二尖瓣血流中测量早期充盈峰值速度（E）和心房收缩峰值速度（A），以计算左右心室的E/A（ER/AR、EL/AL）。肺功能测试得出用力肺活量，并将其表示为与预测值的比值，作为肺血管床面积的指标。
在不增加前负荷的情况下，术后心功能与术前相当。在术后用力肺活量≤术前值80%的患者中，增加前负荷后，术后ER/AR低于术前。术后与术前的ER/AR比值与用力肺活量比值之间（r = 0.66，p = 0.0028）以及右心室Tei指数与用力肺活量比值之间（r = 0.61，p = 0.0034）存在显著相关性。右心室Tei指数有可能间接反映肺血管床面积的状态。
右心室Tei指数有助于评估术前和术后整体右心室功能。在术后右心室Tei指数比术前增加>0.1的患者中，未发现术前ER/AR与EL/AL之间存在密切关系（r = 0.70，p = 0.0004）。肺切除可能对右心室舒张功能的影响大于左心室，这可能是因为术后增加前负荷时心房收缩增强，提示右心室顺应性降低。
