Kukucka Marian, Nasseri Boris, Tscherkaschin Alexander, Mladenow Alexander, Kuppe Hermann, Habazettl Helmut
Department of Anaesthesiology, Deutsches Herzzentrum, Berlin, Germany.
J Cardiothorac Vasc Anesth. 2009 Aug;23(4):462-7. doi: 10.1053/j.jvca.2008.12.002. Epub 2009 Feb 13.
The authors aimed to examine the feasibility of intraoperative transesophageal echocardiography (TEE) acquisition of a non-Doppler-based, speckle tracking-derived myocardial deformation parameter (strain) immediately before and after coronary artery bypass graft (CABG) surgery in patients with reduced left ventricular (LV) function.
A clinical study.
The cardiac surgery operating room of a tertiary referral institution.
Ten patients with reduced LV function (ejection fraction lower than 35%) undergoing coronary revascularization were studied before and immediately after the procedure.
Perioperative TEE.
A total of 120 myocardial segments were analyzed before and after CABG surgery. In visually obtained wall motion scoring (WMS), there were 29 normokinetic (N), 69 hypokinetic (H), 19 akinetic (A), and 3 dyskinetic (D) segments preoperatively and 26 N, 65 H, 21 A, and 8 D segments after CABG surgery. Preoperative radial strain correlated well with WMS (R = 0.82, p < 0.0001), whereas longitudinal strain showed only a weak correlation (R = 0.36, p < 0.0001). Postoperatively, correlations were similar. Interobserver variability as analyzed by kappa-statistics showed better agreement for radial (kappa = 0.82 +/- 0.05, p = 0.001) and longitudinal strain (kappa = 0.73 +/- 0.06, p = 0.004) than for WMS (kappa = 0.65 +/- 0.06). Preoperatively, strain was markedly greater in normally perfused segments than in ischemic segments, whereas the mean WMS revealed only minor differences.
Strain calculation from TEE images is feasible during cardiac surgery and correlates well with WMS but has better interobserver agreement. Strain analysis, but not WMS, detected wall motion differences between normally perfused and ischemic segments. This simple method allows objective intraoperative quantification of myocardial segment function and may become an important monitoring tool in the future.
作者旨在探讨在左心室（LV）功能降低的患者冠状动脉旁路移植术（CABG）手术前后即刻，通过术中经食管超声心动图（TEE）获取基于非多普勒散斑追踪得出的心肌变形参数（应变）的可行性。
一项临床研究。
一家三级转诊机构的心脏外科手术室。
对10例左心室功能降低（射血分数低于35%）且接受冠状动脉血运重建的患者在手术前后即刻进行研究。
围手术期经食管超声心动图检查。
共对CABG手术前后的120个心肌节段进行分析。在视觉获得的室壁运动评分（WMS）中，术前有29个正常运动（N）节段、69个运动减弱（H）节段、19个运动消失（A）节段和3个运动失调（D）节段，CABG手术后分别有26个N节段、65个H节段、21个A节段和8个D节段。术前径向应变与WMS相关性良好（R = 0.82，p < 0.0001），而纵向应变仅显示出弱相关性（R = 0.36，p < 0.0001）。术后，相关性相似。通过kappa统计分析的观察者间变异性显示，径向应变（kappa = 0.82 ± 0.05，p = 0.001）和纵向应变（kappa = 0.73 ± 0.06，p = 0.004）的一致性优于WMS（kappa = 0.65 ± 0.06）。术前，正常灌注节段的应变明显大于缺血节段，而平均WMS仅显示出微小差异。
在心脏手术期间通过TEE图像计算应变是可行的，且与WMS相关性良好，但观察者间一致性更好。应变分析而非WMS检测到了正常灌注节段和缺血节段之间的室壁运动差异。这种简单方法可在术中客观量化心肌节段功能，未来可能成为一种重要的监测工具。
