Bolliger Daniel, Poltera Corsin, Cheung Albert T, Couture Pierre, Michaux Isabelle, Poelaert Jan, Preisman Sergey, Skarvan Karl, Buse Giovanna Lurati, Seeberger Manfred D
Department of Anesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
Department of Anesthesia, University of Pennsylvania, Philadelphia, USA.
Turk J Anaesthesiol Reanim. 2017 Dec;45(6):367-373. doi: 10.5152/TJAR.2017.25483. Epub 2017 Nov 29.
Normative values of left ventricular (LV) end-diastolic area and diameter (EDA and EDD) for intraoperative transoesophageal echocardiography (TEE) have not been established. We aimed to define the ranges of LV EDA and EDD for intraoperative TEE examinations in patients undergoing coronary artery bypass graft (CABG) surgery.
A MEDLINE search for studies reporting LV EDA and EDD in CABG patients was performed. Individual-level dataset from 333 anaesthetised and mechanically ventilated patients with preserved LV function (study population) were received from 8 studies. EDA and calculated EDD values in the study population were compared with summary mean EDD values obtained by transthoracic echocardiography (TTE) in 2 studies of 500 awake patients with coronary artery disease (CAD). Further, the influence of prespecified factors on EDD was evaluated through a multivariate regression model.
LV EDA and EDD values measured by TEE in anaesthetised CABG patients were 16.7±4.7 cm and 4.6±0.6 cm, respectively. EDD values measured by TEE in anaesthetised patients were 10% to 13% less those measured by TTE in 2 studies of awake patients (p<0.001). Body surface area, age and fractional area change but not sex were factors that affected LV EDD.
LV EDD values measured by intraoperative TEE in anaesthetised and mechanically ventilated CABG patients were 10% to 13% less than those measured by TTE in awake CAD patients. This finding indicates that independent normative values specific for intraoperative TEE should be established for guiding intraoperative clinical decisions.
术中经食管超声心动图（TEE）检查时左心室（LV）舒张末期面积和直径（EDA和EDD）的正常参考值尚未确定。我们旨在明确接受冠状动脉旁路移植术（CABG）的患者术中TEE检查时LV EDA和EDD的范围。
对报道CABG患者LV EDA和EDD的研究进行了MEDLINE检索。从8项研究中获取了333例左心室功能正常的麻醉和机械通气患者（研究人群）的个体水平数据集。将研究人群中的EDA和计算得到的EDD值与2项针对500例清醒冠心病（CAD）患者的经胸超声心动图（TTE）研究中获得的汇总平均EDD值进行比较。此外，通过多变量回归模型评估预先设定的因素对EDD的影响。
麻醉的CABG患者经TEE测量的LV EDA和EDD值分别为16.7±4.7 cm和4.6±0.6 cm。在2项针对清醒患者的研究中，麻醉患者经TEE测量的EDD值比经TTE测量的EDD值低10%至13%（p<0.001）。体表面积、年龄和面积变化分数而非性别是影响LV EDD的因素。
麻醉和机械通气的CABG患者术中经TEE测量的LV EDD值比清醒CAD患者经TTE测量的LV EDD值低10%至13%。这一发现表明，应建立针对术中TEE的独立正常参考值，以指导术中临床决策。
