Kuwajima Ken, Ogawa Mana, Ruiz Irving, Hasegawa Hiroko, Yagi Nobuichiro, Rader Florian, Siegel Robert J, Shiota Takahiro
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Am J Cardiol. 2024 Jan 15;211:72-78. doi: 10.1016/j.amjcard.2023.10.045. Epub 2023 Oct 22.
Previous studies have indicated a reduction in right ventricular (RV) longitudinal motion after cardiac surgery. However, the long-term effect of cardiac surgery on longitudinal motion and the involvement of left ventricular (LV) motion remains unclear. Therefore, this study aimed to comprehensively investigate the longitudinal function of the right ventricle and left ventricle in patients who underwent cardiac surgery. The study included patients who underwent comprehensive transthoracic echocardiography with 3-dimensional RV data sets. By propensity score matching of the clinical and echocardiographic variables, including LV and RV ejection fraction, the echocardiographic parameters were compared between patients with and without a history of cardiac surgery (the surgery and nonsurgery groups, respectively). In this study, the surgery group had significantly lower LV global longitudinal strain values than the nonsurgery group, despite having similar LV ejection fraction. The tricuspid annular plane systolic excursion (TAPSE), tricuspid annular velocity, and RV free wall longitudinal strain were also significantly smaller in the surgery group, whereas the RV ejection fraction was comparable between the 2 groups. In addition, a subgroup analysis based on the time from previous surgery to transthoracic echocardiography (≤1 and >1 year) revealed that TAPSE was reduced in both postoperative phases. In conclusion, LV and RV longitudinal parameters were reduced after cardiac surgery, despite preserved LV and RV global functions. Moreover, TAPSE was reduced even after a long time after cardiac surgery. These findings emphasize the need for careful interpretation of biventricular longitudinal motion in patients with a history of cardiac surgery.
先前的研究表明，心脏手术后右心室（RV）纵向运动减少。然而，心脏手术对纵向运动的长期影响以及左心室（LV）运动的参与情况仍不清楚。因此，本研究旨在全面调查接受心脏手术患者的右心室和左心室纵向功能。该研究纳入了接受经胸超声心动图检查并获取三维右心室数据集的患者。通过对包括左心室和右心室射血分数在内的临床和超声心动图变量进行倾向得分匹配，比较了有和没有心脏手术史的患者（分别为手术组和非手术组）之间的超声心动图参数。在本研究中，尽管手术组和非手术组的左心室射血分数相似，但手术组的左心室整体纵向应变值显著低于非手术组。手术组的三尖瓣环平面收缩期位移（TAPSE）、三尖瓣环速度和右心室游离壁纵向应变也显著较小，而两组之间的右心室射血分数相当。此外，基于上次手术至经胸超声心动图检查的时间（≤1年和>1年）进行的亚组分析显示，两个术后阶段的TAPSE均降低。总之，尽管左心室和右心室整体功能得以保留，但心脏手术后左心室和右心室纵向参数仍降低。此外，即使在心脏手术后很长时间，TAPSE仍降低。这些发现强调了对有心脏手术史患者的双心室纵向运动进行仔细解读的必要性。
