全球纵向、环向和径向应变比较预测心脏手术后结局。
A Comparison of Global Longitudinal, Circumferential, and Radial Strain to Predict Outcomes After Cardiac Surgery.
机构信息
Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA.
出版信息
J Cardiothorac Vasc Anesth. 2019 May;33(5):1315-1322. doi: 10.1053/j.jvca.2018.10.031. Epub 2018 Oct 24.
OBJECTIVE
Myocardial strain measured by speckle-tracking echocardiography detects subtle regional and global left ventricular dysfunction. Myocardial strain is measured in the longitudinal, circumferential, and radial dimensions; however, it is unclear which dimension of strain is the best predictor of postoperative outcomes.
DESIGN
A secondary analysis of prospectively collected data from a clinical trial (NCT01187329).
SETTING
The cardiothoracic surgical operating rooms of an academic tertiary-care center.
PARTICIPANTS
Cardiothoracic surgery patients with aortic stenosis having aortic valve replacement (AVR) with or without coronary artery bypass grafting enrolled in a clinical trial.
INTERVENTIONS
Myocardial deformation analysis from standardized investigative transesophageal echocardiographic examinations performed after induction of anesthesia.
MEASUREMENTS AND MAIN RESULTS
The authors compared the ability of intraoperative global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) strain to predict adverse postoperative outcomes, including prolonged hospitalization and the need for pharmacologic hemodynamic support after cardiac surgery. The association of GLS, GCS, and GRS with prolonged hospitalization (>7 days) and the need for pharmacologic hemodynamic support, with epinephrine or norepinephrine after cardiopulmonary bypass, were assessed using separate multivariable logistic regression models with adjustment for multiple comparisons. Of 100 patients, 86 had acceptable measurements for GLS analysis, 73 for GCS, and 72 for GRS. Worse GLS was associated with prolonged hospitalization [odds ratio [OR] (98.3% confidence interval [CI]) of 1.21 (1.01-1.46) per-unit worsening in strain (p = 0.01, significance criterion <0.0167)] and the need for inotropic support with epinephrine [OR (99.2% CI) of 1.81 (1.10-2.97) per-unit worsening in strain (p = 0.002, significance criterion <0.0083)], but not norepinephrine. GCS and GRS were not associated with adverse outcomes.
CONCLUSION
GLS, but not GCS or GRS, predicts prolonged hospitalization and the requirement for inotropic support with epinephrine after AVR.
目的
斑点追踪超声心动图测量的心肌应变可检测到细微的局部和整体左心室功能障碍。心肌应变在纵向、周向和径向三个维度上进行测量；然而，目前尚不清楚应变的哪个维度是术后结果的最佳预测指标。
设计
一项前瞻性临床试验（NCT01187329）数据的二次分析。
地点
学术三级保健中心的心胸外科手术室。
参与者
接受主动脉瓣置换术（AVR）的主动脉瓣狭窄患者，包括接受或不接受冠状动脉旁路移植术的患者，这些患者都参与了一项临床试验。
干预措施
在麻醉诱导后进行标准化的经食管超声心动图检查，进行心肌变形分析。
测量和主要结果
作者比较了术中整体纵向应变（GLS）、整体周向应变（GCS）和整体径向应变（GRS）应变预测术后不良结局的能力，包括住院时间延长和心脏手术后需要药物血流动力学支持。使用多变量逻辑回归模型分别评估 GLS、GCS 和 GRS 与住院时间延长（>7 天）和需要药物血流动力学支持（心肺转流后使用肾上腺素或去甲肾上腺素）的关系，并进行了多次比较调整。在 100 名患者中，86 名患者的 GLS 分析可接受，73 名患者的 GCS 分析可接受，72 名患者的 GRS 分析可接受。GLS 越差与住院时间延长相关[每单位应变恶化的比值比（OR）（98.3%置信区间[CI]）为 1.21（1.01-1.46）（p=0.01，显著性标准<0.0167）]，并且需要使用肾上腺素进行正性肌力支持[OR（99.2%CI）为 1.81（1.10-2.97）（p=0.002，显著性标准<0.0083）]，但与去甲肾上腺素无关。GCS 和 GRS 与不良结局无关。
结论
GLS 但不是 GCS 或 GRS 可预测 AVR 后住院时间延长和需要使用肾上腺素进行正性肌力支持。
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