术前左心室整体纵向应变对预测非心脏大手术患者术后心肌损伤及死亡率的预后价值（SOLOMON研究）

Prognostic value of preoperative left ventricular global longitudinal strain for predicting postoperative myocardial injury and mortality in patients undergoing major non-cardiac surgery (SOLOMON study).

作者信息

Kim Minkwan, Moon Inki, Bae SungA, Seo HyeSun, Jung In Hyun

机构信息

Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea.

Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.

出版信息

Int J Cardiol. 2023 May 1;378:151-158. doi: 10.1016/j.ijcard.2023.02.046. Epub 2023 Mar 1.

DOI:10.1016/j.ijcard.2023.02.046

PMID:36863423

Abstract

BACKGROUND

The usefulness of preoperative measurement of left ventricular global longitudinal strain (LVGLS) for predicting prognosis in patients undergoing non-cardiac surgery has not been evaluated. We analyzed the prognostic value of LVGLS in predicting postoperative 30-day cardiovascular events and myocardial injury after non-cardiac surgery (MINS).

METHODS

This prospective cohort study was conducted in two referral hospitals and included 871 patients who underwent non-cardiac surgery <1 month after preoperative echocardiography. Those with ejection fraction <40%, valvular heart disease, and regional wall motion abnormality were excluded. The co-primary endpoints were the (1) composite incidence of all-cause death, acute coronary syndrome (ACS), and MINS and (2) composite incidence of all-cause death and ACS.

RESULTS

Among the 871 participants enrolled (mean age: 72.9 years; female: 60.8%), there were 43 cases of the primary endpoint (4.9%): 10 deaths, 3 ACS, and 37 MINS. Participants with impaired LVGLS (≤16.6%) had a higher incidence of the co-primary endpoints (log-rank P < 0.001 and 0.015) than those without. The result was similar after adjustment with clinical variables and preoperative troponin T levels (hazard ratio = 1.30, 95% confidence interval [CI] = 1.03-1.65; P = 0.027). In sequential Cox analysis and net reclassification index, LVGLS had an incremental value for predicting the co-primary endpoints after non-cardiac surgery. Among the 538 (61.8%) participants who underwent serial troponin assay, LVGLS predicted MINS independently from the traditional risk factors (odds ratio = 3.54, 95% CI = 1.70-7.36; P = 0.001).

CONCLUSIONS

Preoperative LVGLS has an independent and incremental prognostic value in predicting early postoperative cardiovascular events and MINS.

CLINICAL TRIAL REGISTRATION

URL: https://trialsearch.who.int/. Unique identifiers: KCT0005147.

摘要

背景

术前测量左心室整体纵向应变（LVGLS）对预测非心脏手术患者预后的作用尚未得到评估。我们分析了LVGLS在预测非心脏手术后30天心血管事件和心肌损伤（MINS）方面的预后价值。

方法

这项前瞻性队列研究在两家转诊医院进行，纳入了871例在术前超声心动图检查后<1个月接受非心脏手术的患者。排除射血分数<40%、瓣膜性心脏病和节段性室壁运动异常的患者。共同主要终点为：（1）全因死亡、急性冠状动脉综合征（ACS）和MINS的综合发生率；（2）全因死亡和ACS的综合发生率。

结果

在纳入的871名参与者中（平均年龄：72.9岁；女性：60.8%），有43例发生主要终点事件（4.9%）：10例死亡、3例ACS和37例MINS。LVGLS受损（≤16.6%）的参与者共同主要终点事件的发生率高于未受损者（对数秩检验P<0.001和0.015）。在对临床变量和术前肌钙蛋白T水平进行调整后，结果相似（风险比=1.30，95%置信区间[CI]=1.03-1.65；P=0.027）。在序贯Cox分析和净重新分类指数中，LVGLS在预测非心脏手术后的共同主要终点方面具有增量价值。在538名（61.8%）接受系列肌钙蛋白检测的参与者中，LVGLS独立于传统危险因素预测MINS（比值比=3.54，95%CI=1.70-7.36；P=0.001）。