Anesthesiology Institute, 2569Cleveland Clinic, Cleveland, OH, USA.
Department of Cardiothoracic Anesthesia, 2569Cleveland Clinic, Cleveland, OH, USA.
Semin Cardiothorac Vasc Anesth. 2022 Sep;26(3):226-236. doi: 10.1177/10892532221114791. Epub 2022 Jul 18.
We examined whether intraoperative assessment of left ventricular (LV) twist mechanics is feasible with transesophageal echocardiography (TEE). We then explored whether twist mechanics were altered by hemodynamic conditions or patient comorbidities. In this sub-analysis of clinical trial data, transgastric short-axis echocardiographic images of the LV base and apex were collected in patients having aortic valve replacement (AVR) at baseline and end of surgery. Transvalvular gradients and LV systolic and diastolic function were assessed using two-dimensional (2D) and Doppler echocardiography. 2D speckle-tracking echocardiography was used for off-line analysis of LV twist, twisting rate, and untwisting rate. We examined the intraoperative change in twist mechanics before and after AVR. LV twist mechanics were also explored by diabetic status, need for coronary artery bypass grafting (CABG), and use of epinephrine/norepinephrine. Of 40 patients, 16 patients had acceptable TEE images for off-line LV twist analysis. Baseline median [Q1, Q3] LV twist was 12 [7, 16]°, twisting rate was 72 [41, 97]°/sec, and untwisting rate was -91 [-154, -56]°/s. Median [Q1, Q3] change in LV twist at end of surgery was -2 [-5, 3]°, twisting rate was 7 [-33, 31]°/s, and untwisting rate was 0 [-11, 43]°/s. No difference was noted between diabetic and non-diabetic patients or AVR and AVR-CABG patients. LV twist was augmented in patients with aortic stenosis, though twist indices were not affected by reduced afterload, diabetes, or coronary artery disease. Intraoperative assessment of twist mechanics may provide unique information on LV systolic and diastolic function, though fewer than 50% of TEE examinations successfully assessed twist. This work is a sub-analysis of a clinical trial, registered on ClinicalTrials.gov on August 19, 2010 (NCT01187329), Andra Duncan, Principal Investigator.
我们研究了经食管超声心动图（TEE）是否可用于评估左心室（LV）扭转力学。然后，我们探讨了LV 扭转力学是否会受到血流动力学条件或患者合并症的影响。 在该临床试验数据的亚分析中，在接受主动脉瓣置换术（AVR）的患者中，在基线和手术结束时采集 LV 基底和心尖的经胃短轴超声心动图图像。使用二维（2D）和多普勒超声心动图评估跨瓣梯度和 LV 收缩和舒张功能。使用二维斑点追踪超声心动图对 LV 扭转、扭转率和解旋率进行离线分析。我们检查了 AVR 前后 LV 扭转力学的术中变化。还根据糖尿病状态、是否需要冠状动脉旁路移植术（CABG）以及是否使用肾上腺素/去甲肾上腺素来研究 LV 扭转力学。 在 40 名患者中，有 16 名患者的 TEE 图像可用于离线 LV 扭转分析。基线中位数[Q1，Q3]LV 扭转为 12[7，16]°，扭转率为 72[41，97]°/秒，解旋率为-91[-154，-56]°/s。手术结束时 LV 扭转的中位数[Q1，Q3]变化为-2[-5，3]°，扭转率为 7[-33，31]°/s，解旋率为 0[-11，43]°/s。糖尿病患者与非糖尿病患者或 AVR 与 AVR-CABG 患者之间无差异。 尽管主动脉瓣狭窄患者的 LV 扭转增加，但在降低后负荷、糖尿病或冠状动脉疾病后，扭转指数不受影响。LV 扭转力学的术中评估可能会提供关于 LV 收缩和舒张功能的独特信息，尽管少于 50%的 TEE 检查成功评估了扭转。 这项工作是一项临床试验的亚分析，于 2010 年 8 月 19 日在 ClinicalTrials.gov 上注册（NCT01187329），Andra Duncan 是首席研究员。
