Murukendiran G J, Gadhinglajkar Shrinivas, Sreedhar Rupa, Babu Saravana, Sukesan Subin, Pillai Vivek
Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
J Cardiothorac Vasc Anesth. 2021 Sep;35(9):2723-2731. doi: 10.1053/j.jvca.2020.12.012. Epub 2020 Dec 11.
The primary objective of the present study was to compare cardiac output derived with four methods of QLab (Philips, Amsterdam, Netherlands) software using real-time three-dimensional (3D) transesophageal echocardiography, with cardiac output obtained with the 3D left ventricular outflow tract (LVOT) cardiac output method. The secondary objective was to assess left ventricular (LV) volumes, LV ejection fraction, and cardiac output derived with four different methods of real time 3D transesophageal echocardiography processed in QLab software and to determine whether these parameters differed among these four methods.
A prospective observational study.
A tertiary referral center and a university level teaching hospital.
The study comprised 50 patients scheduled for elective coronary artery bypass surgery without any concomitant valvular lesions.
Three-dimensional full-volume datasets were obtained in optimum conditions. The 3D datasets were analyzed using four different methods in QLab, version 9. In method A, LV volumes were derived without endocardial border adjustment. In method B, LV volumes were obtained after endocardial border adjustment in the long-axis view alone. In method C, the iSlice tool (Philips) was used to adjust the endocardial borders in 16 short-axis slices. In method D, endocardial borders were adjusted after dataset processing to obtain LV volumes. The cardiac output derived with the 3D echocardiography LVOT method was 3.93 ± 1.44 L/min, with method A was 3.26 ± 1.42 L/min, with method B was 3.51 ± 1.2 L/min, with method C was 4.01 ± 1.40 L/min, and with method D was 4.18 ± 1.58 L/min. There was a significant positive correlation between the cardiac output derived using the 3D LVOT method and method C (r = 0.71).
Readjusting the endocardial border contours resulted in higher LV volumes than the volumes estimated using semiautomated border algorithms. The iSlice method produced the highest and the most accurate LV volumes, although it required the longest time to analyze and derive results. The ejection fraction obtained with all four methods of QLab demonstrated no statistical differences and had a strong correlation with the two-dimensional echocardiography-derived left ventricular ejection fraction.
本研究的主要目的是比较使用实时三维（3D）经食管超声心动图的QLab（飞利浦，荷兰阿姆斯特丹）软件的四种方法得出的心输出量与通过3D左心室流出道（LVOT）心输出量方法获得的心输出量。次要目的是评估在QLab软件中处理的四种不同实时3D经食管超声心动图方法得出的左心室（LV）容积、左心室射血分数和心输出量，并确定这些参数在这四种方法之间是否存在差异。
一项前瞻性观察性研究。
一家三级转诊中心和一所大学级教学医院。
该研究包括50例计划进行择期冠状动脉搭桥手术且无任何合并瓣膜病变的患者。
在最佳条件下获取三维全容积数据集。使用QLab 9版本中的四种不同方法分析3D数据集。在方法A中，在不调整心内膜边界的情况下得出LV容积。在方法B中，仅在长轴视图中调整心内膜边界后获取LV容积。在方法C中，使用iSlice工具（飞利浦）在16个短轴切片中调整心内膜边界。在方法D中，在数据集处理后调整心内膜边界以获取LV容积。通过3D超声心动图LVOT方法得出的心输出量为3.93±1.44升/分钟，方法A为3.26±1.42升/分钟，方法B为3.51±1.2升/分钟，方法C为4.01±1.40升/分钟，方法D为4.18±1.58升/分钟。使用3D LVOT方法得出的心输出量与方法C之间存在显著正相关（r = 0.71）。
重新调整心内膜边界轮廓得出的LV容积高于使用半自动边界算法估计的容积。iSlice方法得出的LV容积最高且最准确，尽管分析和得出结果所需时间最长。使用QLab的所有四种方法获得的射血分数均无统计学差异，且与二维超声心动图得出的左心室射血分数具有很强的相关性。
