Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
Department of Cardiac Anesthesia, Narayana Institute of Cardiac Sciences, Narayana Hospitals, Bengaluru, Karnataka, India.
J Cardiothorac Vasc Anesth. 2021 Jun;35(6):1618-1625. doi: 10.1053/j.jvca.2020.11.066. Epub 2020 Dec 9.
Left ventricular diastolic dysfunction (LVDD) is very common among patients undergoing cardiac surgery and is associated with increased mortality and morbidity. The present study tested the hypothesis of whether left atrial strain (LAS) can be used as a single parameter to predict LVDD (per 2016 LVDD evaluation guidelines) and elevated left ventricular filling pressure (LVFP) (ie, LVDD grades II and III) in patients scheduled for off-pump coronary artery bypass grafting (OPCABG) surgery.
A prospective observational study.
Tertiary-care level hospital.
The study comprised 60 patients undergoing elective OPCABG.
None.
Transthoracic echocardiography was performed within 24 hours of surgery by an anesthesiologist. LVDD was graded per American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations for 2016 LVDD guidelines. Left atrial (LA) function was evaluated using two-dimensional strain measurements obtained with the speckle-tracking echocardiography technique. Receiver operating characteristic curves were constructed, and the area under the curve was derived for the prediction of elevated LVFP by LAS. Fourteen (23.3%) patients had elevated LVFP. Global LA reservoir strain (LAS) reduced significantly as the LVDD grade worsened (28.9% ± 8.3%, 21.8% ± 7.2%, 15.6% ± 4.5% and 11.9% ± 1.3%, respectively, for normal LV diastolic function and grades I, II, and III LVDD; p < 0.0001). Similar trends were noted for other components of LAS; namely, global LA conduction, global LA contraction strain, and LAS rate. The ability to predict high LVFP with LAS was statistically significant, with an area under the receiver operating characteristic curve of 0.92 (confidence interval 0.82-0.97; p < 0.001), and a Youden's index for LAS of 19% was obtained with 85.71% sensitivity and 84.78% specificity. The ability of LAS and its components to predict increased LVFP in various subpopulations (normal v reduced ejection fraction) yielded statistically significant results.
In patients scheduled for OPCABG, cardiac anesthesiologists successfully could measure LAS with speckle-tracking echocardiography in the preoperative period. LAS as a single parameter was significantly associated with the grade of LVDD. LAS decreased significantly with worsening grade of LVDD. Furthermore, an LAS value <19% significantly predicted a high LVFP, and LAS predicted high LVFP in both preserved and reduced ejection fraction equally well.
左心室舒张功能障碍（LVDD）在接受心脏手术的患者中非常常见，与死亡率和发病率增加有关。本研究检验了左心房应变（LAS）是否可以作为单一参数预测 LVDD（根据 2016 年 LVDD 评估指南）和升高的左心室充盈压（LVFP）（即 LVDD 等级 II 和 III）的假设在计划进行非体外循环冠状动脉旁路移植术（OPCABG）手术的患者中。
前瞻性观察性研究。
三级护理医院。
该研究纳入了 60 名接受择期 OPCABG 的患者。
无。
麻醉师在术后 24 小时内行经胸超声心动图检查。LVDD 按 2016 年 LVDD 指南的美国超声心动图学会/欧洲心血管成像协会建议进行分级。使用斑点追踪超声心动图技术获得的二维应变测量值评估左心房（LA）功能。绘制受试者工作特征曲线，并得出 LAS 预测 LVFP 升高的曲线下面积。14 名（23.3%）患者存在 LVFP 升高。随着 LVDD 等级恶化，整体 LA 储库应变（LAS）显著降低（正常 LV 舒张功能和 LVDD 等级 I、II 和 III 的分别为 28.9%±8.3%、21.8%±7.2%、15.6%±4.5%和 11.9%±1.3%；p<0.0001）。LAS 的其他成分也呈现出相似的趋势，即整体 LA 传导、整体 LA 收缩应变和 LAS 率。LAS 预测 LVFP 升高的能力具有统计学意义，受试者工作特征曲线下面积为 0.92（置信区间 0.82-0.97；p<0.001），LAS 的约登指数为 19%，灵敏度为 85.71%，特异性为 84.78%。LAS 及其成分在预测各种亚群（正常射血分数与降低的射血分数）中增加的 LVFP 的能力产生了统计学上显著的结果。
在计划接受 OPCABG 的患者中，心脏麻醉师可以在术前使用斑点追踪超声心动图成功测量 LAS。LAS 作为单一参数与 LVDD 等级显著相关。随着 LVDD 等级的恶化，LAS 显著降低。此外，LAS 值<19% 显著预测 LVFP 升高，LAS 预测 LVFP 升高在保留射血分数和降低射血分数患者中同样有效。
