Department of Intensive Care Unit of Nanjing First Hospital, Nanjing Medical University, 210000 Nanjing, Jiangsu, China.
Heart Surg Forum. 2023 Dec 26;26(6):E770-E779. doi: 10.59958/hsf.5921.
Global longitudinal strain (GLS) seems accurate for detecting subclinical myocardial dysfunction. This study aimed to determine the association between GLS and postoperative intensity of inotropic support in the patients undergoing heart valve surgery with preserved left ventricular ejection fraction.
74 patients with preserved left ventricular ejection fraction who underwent valve surgery during the period between March 2021 and June 2022 were included in this prospective observational study. Transthoracic echocardiography including strain analysis with speckle tracking was performed before surgery. Patients were stratified according to the left ventricle (LV) GLS: LV-GLS ≥-16% (Impaired GLS group) and LV-GLS <-16% (Normal GLS group). The primary endpoint was postoperative vasoactive inotropic score. A high vasoactive inotropic score (VIS) was defined as a maximum VIS of ≥15 within 24 hours postoperatively. Postoperative adverse events, baseline clinical and echocardiographic data were also recorded. We invested the ability of preoperative GLS in predicting adverse postoperative outcomes, such as prolonged mechanical ventilation and the need for pharmacologic hemodynamic support after cardiac surgery.
Seventy-four patients were included and analyzed in this study, including thirty-three in impaired GLS group and forty-one in normal GLS group. In-hospital mortality was 1.27% (1/74). Patients in impaired GLS group were more likely to have prolonged mechanical ventilation (p = 0.041). Multivariable logistic regression analysis revealed that the apical four-chamber view of the left ventricle (A4C)-GLS was significantly associated with high VIS (OR 1.373, p = 0.007). A4C-GLS had a sensitivity of 62.5% and a specificity of 89.66% for predicting high VIS (area under the curve, 0.78). The relationships between GLS and other secondary outcome measures were not statistically significant. The optimal cutoff of A4C-GLS for postoperative high vasoactive inotropic score was -10.85%.
Preoperative LV dysfunction is an independent risk factor for postoperative high VIS. A4C-GLS may be a reliable tool in predicting high VIS after cardiac surgery. Those patients with impaired contractility were at high risk for elevated inotropic support and prolonged mechanical ventilation after cardiac surgery. These findings suggest an important role for echocardiographic GLS in perioperative assessment of cardiac function in the patients undergoing cardiac surgery.
整体纵向应变（GLS）似乎可准确检测亚临床心肌功能障碍。本研究旨在确定左心室射血分数保留的心脏瓣膜手术后患者的 GLS 与术后正性肌力支持强度之间的关系。
本前瞻性观察研究纳入了 2021 年 3 月至 2022 年 6 月期间行瓣膜手术且左心室射血分数保留的 74 例患者。手术前进行包括斑点追踪应变分析的经胸超声心动图检查。根据左心室（LV）GLS 将患者分层：LV-GLS≥-16%（受损 GLS 组）和 LV-GLS<-16%（正常 GLS 组）。主要终点是术后血管活性正性肌力评分。高血管活性正性肌力评分（VIS）定义为术后 24 小时内最大 VIS≥15。还记录了术后不良事件、基线临床和超声心动图数据。我们评估了术前 GLS 预测术后不良结局的能力，如心脏手术后机械通气延长和需要药物血流动力学支持。
本研究纳入并分析了 74 例患者，其中受损 GLS 组 33 例，正常 GLS 组 41 例。院内死亡率为 1.27%（1/74）。受损 GLS 组患者机械通气时间延长的可能性更高（p=0.041）。多变量逻辑回归分析显示，左心室心尖四腔观（A4C）-GLS 与高 VIS 显著相关（OR 1.373，p=0.007）。A4C-GLS 预测高 VIS 的灵敏度为 62.5%，特异性为 89.66%（曲线下面积，0.78）。GLS 与其他次要结局指标之间的关系无统计学意义。A4C-GLS 预测术后高血管活性正性肌力评分的最佳截断值为-10.85%。
术前左心室功能障碍是术后高 VIS 的独立危险因素。A4C-GLS 可能是心脏手术后预测高 VIS 的可靠工具。收缩功能受损的患者在心脏手术后有更高的风险需要增加正性肌力支持和延长机械通气。这些发现表明超声心动图 GLS 在心脏手术患者围手术期心脏功能评估中具有重要作用。
