Department of Anesthesiology, Montreal Heart Institute, University of Montréal, Montreal, Quebec, Canada.
J Cardiothorac Vasc Anesth. 2012 Jun;26(3):371-5. doi: 10.1053/j.jvca.2012.02.005. Epub 2012 Mar 28.
To evaluate the accuracy of new intraoperative regional wall motions abnormalities (RWMAs) detected by transesophageal echocardiography (TEE) to predict early postoperative coronary artery graft failure.
A retrospective study.
A tertiary care university hospital.
Five thousand nine hundred ninety-eight patients who underwent coronary artery bypass graft (CABG) surgery.
An evaluation of RWMAs recorded with intraoperative TEE before and after cardiopulmonary bypass (CPB) in patients who had coronary angiography for suspected postoperative myocardial ischemia based on electrocardiogram (ECG), CK-MB, troponin T, hemodynamic compromise, low cardiac output, and malignant ventricular arrhythmia. Sensitivity, specificity, positive and negative predictive values, odds ratio, 95% confidence interval, and chi-square analysis were used.
Thirty-nine patients (0.7%) underwent early coronary angiography for the suspicion of early graft dysfunction. Of the 32 patients with diagnosed early graft dysfunction, 5 patients (15.6%) had shown new intraoperative RWMAs as detected by TEE, 21 patients (65.6%) had no new RWMAs, no report was available in 5 patients (15.6%), and 1 examination (3.1%) was excluded because of poor imaging quality. The sensitivity of TEE to predict graft failure was 15.6%, the specificity was 57.1%, and the positive predictive and negative values were 62.5% and 12.9%, respectively. The odds ratio and 95% confidence interval was 0.1190 (0.0099-1.4257) when TEE was positive compared with coronary angiography. No association was found between new RWMAs detected with TEE and graft failure as documented with coronary angiography (p = 0.106).
In this retrospective study, RWMAs detected with TEE were of limited value to predict early postoperative CABG failure.
评估经食管超声心动图（TEE）检测到的新术中区域性壁运动异常（RWMAs）预测早期冠状动脉旁路移植术（CABG）后冠状动脉移植物失败的准确性。
回顾性研究。
三级护理大学医院。
5998 例行 CABG 手术的患者。
对因心电图（ECG）、CK-MB、肌钙蛋白 T、血流动力学障碍、低心输出量和恶性室性心律失常怀疑术后心肌缺血而接受冠状动脉造影的患者，在体外循环（CPB）前后记录术中 TEE 的 RWMAs。采用敏感性、特异性、阳性和阴性预测值、优势比、95%置信区间和卡方分析。
39 例（0.7%）患者因怀疑早期移植物功能障碍而行早期冠状动脉造影。在诊断为早期移植物功能障碍的 32 例患者中，5 例（15.6%）经 TEE 检测到新的术中 RWMAs，21 例（65.6%）无新的 RWMAs，5 例（15.6%）无报告，1 例（3.1%）因成像质量差而排除。TEE 预测移植失败的敏感性为 15.6%，特异性为 57.1%，阳性预测值和阴性值分别为 62.5%和 12.9%。与冠状动脉造影相比，TEE 阳性时的优势比和 95%置信区间为 0.1190（0.0099-1.4257）。在 TEE 检测到的新的 RWMAs 与冠状动脉造影证实的移植失败之间未发现相关性（p=0.106）。
在这项回顾性研究中，TEE 检测到的 RWMAs 对预测早期 CABG 术后失败的价值有限。
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