Muyskens Steve, Roshan Tony, Honan Kevin, Umejiego Johnbosco, Raynaud Scott, Ogunyankin Fadeke
Department of Pediatric Cardiology, Cook Children's Medical Center, 1500 Cooper Street, 3rd Floor, Fort Worth, TX, 76104, USA.
University of North Texas Health Science Center, Texas College of Osteopathic Medicine, Fort Worth, TX, USA.
Pediatr Cardiol. 2020 Dec;41(8):1660-1666. doi: 10.1007/s00246-020-02425-9. Epub 2020 Aug 1.
Cardiac magnetic resonance imaging (CMR)-derived ejection fraction (EF) predicts adverse outcomes in repaired tetralogy of Fallot (rTOF) and drives timing of pulmonary valve replacement. Certain patient populations require sedation for successful CMR image acquisition. General anesthesia (GA) has been shown to depress EF and heart rate (HR) in animal models, however, its effect on congenital heart disease is unknown. A retrospective review was conducted of all CMR patients referred with rTOF between January 2011 and May 2019. The cohort was separated into GA and non-GA groups. Propensity score matching (PSM) adjusted for selection bias. A kernel matching algorithm was used to match subjects and the differences in mean treatment effect on the treated were computed for left ventricular (LV) and right ventricular (RV) EF, HR, and cardiac index (CI). 143 patients met criteria, 37 patients under GA (mean age 15 years, range 2-45, 59% male), and 106 patients without GA (mean age 21 years, range 10-53, 50% male). Unmatched analysis showed significant depression of LV EF (50 vs. 57%, p < 0.001) and RV EF (42 vs. 48%, p < 0.001) in the GA group compared to the non-GA group. There was no significant difference in HR or CI. After matching and PSM adjustment, the GA group had a significant decrease in LV EF (49 vs. 56%, p < 0.001), RV EF (41 vs. 48%, p < 0.001), CI (2728 vs. 3701 ml/min/m, p < 0.001), and HR (72 vs. 79 bpm, p = 0.04). General anesthesia with sevoflurane results in depressed CMR-derived EF.
心脏磁共振成像（CMR）测定的射血分数（EF）可预测法洛四联症修补术后（rTOF）的不良预后，并决定肺动脉瓣置换的时机。某些患者群体需要镇静才能成功采集CMR图像。在动物模型中，全身麻醉（GA）已被证明会降低EF和心率（HR），然而，其对先天性心脏病的影响尚不清楚。对2011年1月至2019年5月期间所有因rTOF前来就诊的CMR患者进行了回顾性研究。该队列被分为GA组和非GA组。倾向评分匹配（PSM）用于调整选择偏倚。采用核匹配算法对受试者进行匹配，并计算治疗组在左心室（LV）和右心室（RV）EF、HR和心脏指数（CI）方面的平均治疗效果差异。143例患者符合标准，37例接受GA（平均年龄15岁，范围2 - 45岁，59%为男性），106例未接受GA（平均年龄21岁，范围10 - 53岁，50%为男性）。未匹配分析显示，与非GA组相比，GA组的LV EF（50%对57%，p < 0.001）和RV EF（42%对48%，p < 0.001）显著降低。HR或CI无显著差异。匹配和PSM调整后，GA组的LV EF（49%对56%，p < 0.001）、RV EF（41%对48%，p < 0.001）、CI（2728对3701 ml/min/m，p < 0.001）和HR（72对79 bpm，p = 0.04）均显著降低。七氟醚全身麻醉会导致CMR测定的EF降低。
