左心室整体纵向应变与射血分数比较，预测非体外循环冠状动脉旁路移植术患者术中主动脉内球囊反搏置入：一项初步研究。
Comparison of Left Ventricular Global Longitudinal Strain with Ejection Fraction as a Predictor for Peri-operative IABP Insertion in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting: A Pilot Study.
机构信息
Department of Cardiac Anaesthesia and Critical Care, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
出版信息
Ann Card Anaesth. 2023 Jul-Sep;26(3):295-302. doi: 10.4103/aca.aca_144_22.
BACKGROUND
Prophylactic use of intra-aortic balloon pump (IABP) mainly depends on left ventricular (LV) systolic function. Global longitudinal strain (GLS) is a robust prognostic parameter for LV strain. It has proved to be more sensitive than LV ejection fraction (EF) as a measure of LV systolic function and is a strong predictor of outcome.
AIM
To determine whether GLS can be used as a reliable marker and its cut-off value for IABP insertion in patients undergoing elective off-pump coronary artery bypass grafting (OPCABG).
SETTINGS AND DESIGN
A prospective observational clinical study which included 100 adult patients scheduled for elective OPCABG.
MATERIALS AND METHODS
Two-dimensional (2D) speckle tracking echocardiography (STE)-estimated GLS was computed and compared with LV EF measured by three dimensional (3D) echocardiography for the insertion of IABP. The intensive care unit (ICU) parameters were correlated with echocardiographic parameters to predict early post-operative outcome.
RESULTS
IABP insertion correlates better with GLS (post-revascularization > pre-revascularization) than with 3D LV EF. Receiver operating characteristic (ROC) curve analysis revealed the highest area under the curve (AUC, 0.972) with a cut-off value of > -9.8% for GLS compared to 3D LV EF (AUC, 0.938) with a cut-off value of ≤ 44%. ICU parameters show better correlation with E/e'> GLS > WMSI than 3D LV EF.
CONCLUSION
GLS is a better predictor of IABP insertion compared to 3D LV EF in patients undergoing OPCABG.
背景
主动脉内球囊反搏（IABP）的预防性使用主要取决于左心室（LV）收缩功能。整体纵向应变（GLS）是 LV 应变的一种强大的预后参数。它已被证明比 LV 射血分数（EF）作为 LV 收缩功能的测量更为敏感，并且是结局的强有力预测指标。
目的
确定 GLS 是否可用作接受择期非体外循环冠状动脉旁路移植术（OPCABG）的患者中 IABP 插入的可靠标志物及其截断值。
设置和设计
这是一项包括 100 例择期 OPCABG 成年患者的前瞻性观察性临床研究。
材料和方法
使用二维（2D）斑点追踪超声心动图（STE）估算 GLS，并将其与通过三维（3D）超声心动图测量的 LV EF 进行比较，以确定 IABP 的插入。将重症监护病房（ICU）参数与超声心动图参数相关联，以预测术后早期结局。
结果
IABP 插入与 GLS（再血管化后>再血管化前）的相关性优于与 3D LV EF 的相关性。接收者操作特性（ROC）曲线分析显示，与 3D LV EF（截断值≤44%，AUC 为 0.938）相比，GLS 的曲线下面积（AUC）最高（截断值> -9.8%，AUC 为 0.972）。与 3D LV EF 相比，ICU 参数与 E/e'、GLS 和 WMSI 的相关性更好。
结论
与 3D LV EF 相比，GLS 是 OPCABG 患者中 IABP 插入的更好预测指标。
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