经胸超声心动图术前即时评估左心室收缩功能障碍。

Preoperative Point-of-Care Assessment of Left Ventricular Systolic Dysfunction With Transthoracic Echocardiography.

机构信息

From the Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Sunderby).

Department of Public Health and Clinical Medicine, Section of Medicine.

出版信息

Anesth Analg. 2021 Mar 1;132(3):717-725. doi: 10.1213/ANE.0000000000005263.

DOI:10.1213/ANE.0000000000005263

PMID:33177328

Abstract

BACKGROUND

Left ventricular (LV) systolic dysfunction is an acknowledged perioperative risk factor and should be identified before surgery. Conventional echocardiographic assessment of LV ejection fraction (LVEF) obtained by biplane LV volumes is the gold standard to detect LV systolic dysfunction. However, this modality needs extensive training and is time consuming. Hence, a feasible point-of-care screening method for this purpose is warranted. The aim of this study was to evaluate 3 point-of-care echocardiographic methods for identification of LV systolic dysfunction in comparison with biplane LVEF.

METHODS

One hundred elective surgical patients, with a mean age of 63 ± 12 years and body mass index of 27 ± 4 kg/m2, were consecutively enrolled in this prospective observational study. Transthoracic echocardiography was conducted 1-2 hours before surgery. LVEF was obtained by automatic two-dimensional (2D) biplane ejection fraction (EF) software. We evaluated if Tissue Doppler Imaging peak systolic myocardial velocities (TDISm), anatomic M-mode E-point septal separation (EPSS), and conventional M-mode mitral annular plane systolic excursion (MAPSE) could discriminate LV systolic dysfunction (LVEF <50%) by calculating accuracy, efficiency, correlation, positive (PPV) respective negative predictive (NPV) values, and area under the receiver operating characteristic curve (AUROC) for each point-of-care method.

RESULTS

LVEF<50% was identified in 22% (21 of 94) of patients. To discriminate an LVEF <50%, AUROC for TDISm (mean <8 cm/s) was 0.73 (95% confidence interval [CI], 0.62-0.84; P < .001), with a PPV of 47% and an NPV of 90%. EPSS with a cutoff value of >6 mm had an AUROC 0.89 (95% CI, 0.80-0.98; P < .001), with a PPV of 67% and an NPV of 96%. MAPSE (mean <12 mm) had an AUROC 0.80 (95% CI, 0.70-0.90; P < 0.001) with a PPV of 57% and an NPV of 98%.

CONCLUSIONS

All 3 point-of-care methods performed reasonably well to discriminate patients with LVEF <50%. The clinician may choose the most suitable method according to praxis and observer experience.

摘要

背景

左心室（LV）收缩功能障碍是公认的围手术期危险因素，应在手术前确定。通过双平面 LV 容积获得的 LV 射血分数（LVEF）的传统超声心动图评估是检测 LV 收缩功能障碍的金标准。然而，这种方式需要广泛的培训并且耗时。因此，有必要为此目的制定一种可行的即时护理筛选方法。本研究的目的是评估 3 种即时护理超声心动图方法在识别 LV 收缩功能障碍方面与双平面 LVEF 的比较。

方法

连续纳入 100 例择期手术患者，平均年龄 63 ± 12 岁，体重指数 27 ± 4 kg/m2。在手术前 1-2 小时进行经胸超声心动图检查。使用自动二维（2D）双平面射血分数（EF）软件获得 LVEF。我们评估了组织多普勒成像峰值收缩心肌速度（TDISm）、解剖 M 型 E 点室间隔分离（EPSS）和常规 M 型二尖瓣环平面收缩期位移（MAPSE）是否可以通过计算准确性、效率、相关性、阳性（PPV）各自的阴性预测值（NPV）和每个即时护理方法的接收者操作特征曲线（AUROC）来区分 LV 收缩功能障碍（LVEF <50%）。

结果

22%（94 例中的 21 例）患者的 LVEF<50%。为了区分 LVEF<50%，TDISm（平均<8cm/s）的 AUROC 为 0.73（95%置信区间[CI]，0.62-0.84；P<.001），PPV 为 47%，NPV 为 90%。EPSS 的截断值>6mm 的 AUROC 为 0.89（95%CI，0.80-0.98；P<.001），PPV 为 67%，NPV 为 96%。MAPSE（平均值<12mm）的 AUROC 为 0.80（95%CI，0.70-0.90；P<.001），PPV 为 57%，NPV 为 98%。