Ștef Adrian, Bodolea Constantin, Bocșan Ioana Corina, Achim Alexandru, Tintiuc Nadina, Pop Raluca Maria, Solomonean Aurelia Georgeta, Manea Alexandru, Buzoianu Anca Dana
Clinical Department of Anesthesia and Intensive Care, Heart Institute "Niculae Stancioiu", University of Medicine and Pharmacy "Iuliu Hatieganu", Motilor 19-21, 400001 Cluj-Napoca, Romania.
Department of Surgery, Discipline of Anesthesia and Intensive Care 2, University of Medicine and Pharmacy "Iuliu Hatieganu", Victor Babes Nr. 8 Street, 400012 Cluj-Napoca, Romania.
J Pers Med. 2024 Aug 10;14(8):850. doi: 10.3390/jpm14080850.
: The perioperative impact of calcium and vitamin D on left ventricular (LV) performance during major cardiac surgery remains unexplored. We aimed to assess the relation of calcium and vitamin D measured at different time points with the LV ejection fraction (EF), and to investigate whether changes in EF correlate with postoperative outcomes. : We enrolled 83 patients, in whom ionized calcium was measured before, during, and after surgery (until discharge), vitamin D preoperatively, and EF pre- and postoperatively at 24 h. The postoperative outcomes were cardiopulmonary bypass (CPB) time, aortic cross-clamp time, mechanical ventilation time, vasoactive inotropic score (VIS) (intraoperative, day 0, day 1), and ICU stay time. : The mean age was 64.9 ± 8.5 years, with 21 of the patients (25%) having an EF < 50%. The median change from preoperative to postoperative EF was -2.0 (-10.0-0.0) % ( < 0.001). At the baseline, the EF < 50% group had significantly lower preoperative vitamin D levels than the EF ≥ 50% group ( = 0.048). The calcium trend did not differ across the groups. Preoperative EF was significantly associated with CPB time (r = 0.22, = 0.044) and aortic cross-clamp time (r = 0.24, = 0.031). Postoperative EF was significantly and inversely associated with intraoperative VIS (r = -0.28, = 0.009), VIS day 0 (r = -0.25, = 0.020), VIS day 1 (r = -0.23, = 0.036), and ICU length of stay (r = -0.22, = 0.047). Finally, the change in ejection fraction was significantly and inversely associated with CPB time (r = -0.23, = 0.037), aortic cross-clamp time (r = -0.22, = 0.044), intraoperative VIS (r = -0.42, < 0.001), VIS day 0 (r = -0.25, = 0.024), mechanical ventilation time (r = -0.22, = 0.047), and ICU length of stay (r = -0.23, = 0.039). : The fluctuations in perioperative ionized calcium levels were not associated with the evolution of LVEF, although preoperative vitamin D levels may affect those with low EF. Correspondingly, a reduced EF significantly impacted all the studied postoperative outcomes. Further investigation into biomarkers affecting cardiac inotropic function is warranted to better understand their significance.
钙和维生素D对心脏大手术期间左心室（LV）功能的围手术期影响尚不清楚。我们旨在评估不同时间点测量的钙和维生素D与左心室射血分数（EF）的关系，并研究EF的变化是否与术后结果相关。
我们纳入了83例患者，在手术前、手术期间和手术后（直至出院）测量了离子钙，术前测量了维生素D，术前和术后24小时测量了EF。术后结果包括体外循环（CPB）时间、主动脉阻断时间、机械通气时间、血管活性药物评分（VIS）（术中、术后第0天、术后第1天）和重症监护病房（ICU）住院时间。
患者的平均年龄为64.9±8.5岁，其中21例患者（25%）的EF<50%。术前至术后EF的中位数变化为-2.0（-10.0-0.0）%（P<0.001）。在基线时，EF<50%组的术前维生素D水平显著低于EF≥50%组（P=0.048）。各组之间的钙变化趋势无差异。术前EF与CPB时间（r=0.22，P=0.044）和主动脉阻断时间（r=0.24，P=0.031）显著相关。术后EF与术中VIS（r=-0.28，P=0.009）、术后第0天VIS（r=-0.25，P=0.020）、术后第1天VIS（r=-0.23，P=0.036）和ICU住院时间（r=-0.22，P=0.047）显著负相关。最后，射血分数的变化与CPB时间（r=-0.23，P=0.037）、主动脉阻断时间（r=-0.22，P=0.044）、术中VIS（r=-0.42，P<0.001）、术后第0天VIS（r=-0.25，P=0.024）、机械通气时间（r=-0.22，P=0.047）和ICU住院时间（r=-0.23，P=0.039）显著负相关。
围手术期离子钙水平的波动与左心室射血分数的变化无关，尽管术前维生素D水平可能会影响射血分数低的患者。相应地，EF降低对所有研究的术后结果都有显著影响。有必要进一步研究影响心脏变力功能的生物标志物，以更好地了解它们的意义。
