Kyle Bonnie, Zawadka Mateusz, Shanahan Hilary, Cooper Jackie, Rogers Andrew, Hamarneh Ashraf, Sivaraman Vivek, Anwar Sibtain, Smith Andrew
Perioperative Medicine, Barts Heart Centre, St. Bartholomew's Hospital, London EC1A 7BE, UK.
NIHR Biomedical Research Centre, William Harvey Research Institute, Barts, Queen Mary University of London, London E1 4NS, UK.
J Clin Med. 2021 Nov 7;10(21):5198. doi: 10.3390/jcm10215198.
Diastolic dysfunction is associated with major adverse outcomes following cardiac surgery. We hypothesized that multisystem endpoints of morbidity would be higher in patients with diastolic dysfunction. A total of 142 patients undergoing cardiac surgical procedures with cardiopulmonary bypass were included in the study. Intraoperative assessments of diastolic function according to the 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines using transesophageal echocardiography were performed. Cardiac Postoperative Morbidity Score (CPOMS) on days 3, 5, 8, and 15; length of stay in ICU and hospital; duration of intubation; incidence of new atrial fibrillation; 30-day major adverse cardiac and cerebrovascular events were recorded. Diastolic function was determinable in 96.7% of the dataset pre and poststernotomy assessment ( = 240). Diastolic dysfunction was present in 70.9% ( = 88) of measurements before sternotomy and 75% ( = 93) after sternal closure. Diastolic dysfunction at either stage was associated with greater CPOMS on D5 ( = 0.009) and D8 ( = 0.009), with CPOMS scores 1.24 ( = 0.01) higher than in patients with normal function. Diastolic dysfunction was also associated with longer durations of intubation ( = 0.001), ICU length of stay ( = 0.019), and new postoperative atrial fibrillation ( = 0.016, OR (95% CI) = 4.50 (1.22-25.17)). We were able to apply the updated ASE/EACVI guidelines and grade diastolic dysfunction in the majority of patients. Any grade of diastolic dysfunction was associated with greater all-cause morbidity, compared with patients with normal diastolic function.
舒张功能障碍与心脏手术后的主要不良结局相关。我们假设，舒张功能障碍患者的多系统发病终点会更高。本研究共纳入了142例行体外循环心脏手术的患者。根据2016年美国超声心动图学会和欧洲心血管影像协会指南，使用经食管超声心动图对舒张功能进行术中评估。记录术后第3天、第5天、第8天和第15天的心脏术后发病率评分（CPOMS）；重症监护病房（ICU）和医院的住院时间；插管持续时间；新发房颤的发生率；30天主要不良心脑血管事件。在胸骨切开术前和术后评估的96.7%的数据集中（n = 240）可确定舒张功能。胸骨切开术前70.9%（n = 88）的测量值和胸骨关闭后75%（n = 93）存在舒张功能障碍。任何一个阶段的舒张功能障碍均与术后第5天（P = 0.009）和第8天（P = 0.009）更高的CPOMS相关，CPOMS评分比功能正常的患者高1.24（P = 0.01）。舒张功能障碍还与更长的插管持续时间（P = 0.001）、ICU住院时间（P = 0.019）以及术后新发房颤（P = 0.016，OR（95%CI）= 4.50（1.22 - 25.17））相关。我们能够应用更新后的ASE/EACVI指南对大多数患者的舒张功能障碍进行分级。与舒张功能正常的患者相比，任何级别的舒张功能障碍均与更高的全因发病率相关。
