Rahmat Budi, Dwita Nurima Ulya, Arya Wardana Putu Wisnu, Lilyasari Oktavia
Pediatric and Congenital Heart Surgery Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
Department of Thoracic, Cardiac and Vascular Surgery, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.
Front Pediatr. 2021 Dec 24;9:705257. doi: 10.3389/fped.2021.705257. eCollection 2021.
Low cardiac output syndrome is one of the postoperative complications that are associated with significant morbidity and mortality after surgical closure of atrial septal defect (ASD) with small-sized left ventricle (LV). This study investigated whether preoperative left ventricular end-diastolic volume index (LVEDVi) could accurately predict low cardiac output syndrome (LCOS) after surgical closure of ASD with small-sized LV. This retrospective cohort study involved adult ASD patients with small-sized LV from January 2018 to December 2019 in National Cardiovascular Center Harapan Kita. Preoperative MRI data to assess the left and right ventricle volume were collected. A bivariate analysis using independent Student's -test was done. Diagnostic test using receiver operating characteristic (ROC) curve was also done to obtain the area under the curve (AUC) value. The best cutoff point was determined by Youden's index. Fifty-seven subjects were involved in this study [age (mean ± SD) 32.56 ± 13.15 years; weight (mean ± SD) 48.82 ± 12.15 kg]. Subjects who had post-operative LCOS ( = 30) have significantly lower LVEDVi (45.0 ± 7.42 ml/m vs. 64.15 ± 13.37 ml/m; < 0.001), LVEDV (64.6 ± 16.0 ml vs. 85.9 ± 20.7 ml; < 0.001), LVSV (38.97 ± 11.5 ml vs. 53.13 ± 7.5 ml; < 0.001), and LVSVi (27.28 ± 8.55 ml/m vs. 37.42 ± 5.35 ml/m; < 0.001) compared to subjects who did not have post-operative LCOS ( = 27). ROC analysis showed that the best AUC was found on LVEDVi (AUC 95.3%; 95% confidence interval: 90.6-100%). The best cutoff value for LVEDVi to predict the occurrence of LCOS after surgical closure of ASD was 53.3 ml/m with a sensitivity of 86.7% and a specificity of 85.2%. This study showed that preoperative LVEDVi could predict LCOS after surgical closure of ASD with small-sized LV with a well-defined cutoff. The best cutoff value of LVEDVi to predict the occurrence of LCOS after surgical ASD closure was 53.5 ml/m.
低心排血量综合征是小型左心室（LV）房间隔缺损（ASD）手术闭合术后的严重并发症之一，与显著的发病率和死亡率相关。本研究调查了术前左心室舒张末期容积指数（LVEDVi）能否准确预测小型LV的ASD手术闭合术后的低心排血量综合征（LCOS）。这项回顾性队列研究纳入了2018年1月至2019年12月在哈帕恩基塔国家心血管中心的成年小型LV的ASD患者。收集术前评估左、右心室容积的MRI数据。采用独立样本t检验进行双变量分析。还进行了使用受试者工作特征（ROC）曲线的诊断试验以获得曲线下面积（AUC）值。通过约登指数确定最佳截断点。本研究纳入了57名受试者[年龄（均值±标准差）32.56±13.15岁；体重（均值±标准差）48.82±12.15kg]。术后发生LCOS的受试者（n = 30）的LVEDVi（45.0±7.42ml/m² 对比 64.15±13.37ml/m²；P<0.001）、LVEDV（64.6±16.0ml对比85.9±20.7ml；P<0.001）、LVSV（38.97±11.5ml对比53.13±7.5ml；P<0.001）和LVSVi（27.28±8.55ml/m² 对比37.42±5.35ml/m²；P<0.001）均显著低于未发生术后LCOS的受试者（n = 27）。ROC分析显示，LVEDVi的AUC最佳（AUC 95.3%；95%置信区间：90.6 - 100%）。预测小型LV的ASD手术闭合术后LCOS发生的LVEDVi最佳截断值为53.3ml/m²，敏感性为86.7%，特异性为85.2%。本研究表明，术前LVEDVi可以通过明确的截断值预测小型LV的ASD手术闭合术后的LCOS。预测ASD手术闭合术后LCOS发生的LVEDVi最佳截断值为53.5ml/m²。
