Xiao Jie, Li Tao, Wang Yingsong, Zhao Zhi, Xie Jingming, Zhou Jin
Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, 374 # Dianmian Road, Kunming, 650101, Yunnan, P.R. China.
J Orthop Surg Res. 2025 Jul 19;20(1):681. doi: 10.1186/s13018-025-06113-3.
Severe scoliosis may impair cardiac structure and function. This study aims to evaluate the cardiac structural and functional changes in patients with severe thoracic scoliosis at rest, using echocardiography to inform perioperative strategies.
This retrospective cohort analysis included 294 patients with idiopathic scoliosis (IS) characterized by primary thoracic curvature and no history of previous spinal surgery. The study included 97 patients with severe scoliosis (defined as a Cobb angle ≥ 90°) and 197 patients with a Cobb angle < 90°, who were categorized as Non-severe scoliosis. General data, including age, gender, height, weight, BMI, and primary thoracic curve characteristics, were collected for all patients. Subgroup analyses were conducted based on age, gender, Cobb angle, and curve direction. Cardiac metrics, including structural and functional parameters, were compared, and correlations between Cobb angle and cardiac indicators in severe scoliosis were assessed.
Patients with severe scoliosis exhibited significantly reduced cardiac parameters, including left ventricular diastolic diameter (LVDd), right ventricular diastolic diameter (RVDd), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), ejection fraction (EF), and fractional shortening (FS) (p < 0.05). Subgroup analysis revealed lower LVDd and cardiac index (CI) in patients with Cobb angles ≥ 120° compared to 90-120° (p < 0.05). The direction of the thoracic curve did not significantly impact cardiac structure or function (p > 0.05). Patients older than 18 years had significantly larger cardiac structural parameters than younger patients, although cardiac function remained similar. Male patients exhibited greater right heart dimensions compared to females. Correlation analysis demonstrated a negative association between Cobb angle and LVDd and CI (p < 0.05).
Severe thoracic scoliosis significantly affects cardiac structure and function at rest, primarily impacting left ventricular dimensions and cardiac index. Age and gender influence specific cardiac structural parameters but have a limited impact on cardiac function. Preoperative assessments should prioritize LVDd and CI for a thorough evaluation of cardiac health in these patients. The direction of the primary thoracic curve does not significantly influence cardiac structure or function. The severity of the spinal deformity, rather than the curvature direction, is the main determinant of its impact on cardiac health.
严重脊柱侧弯可能损害心脏结构和功能。本研究旨在利用超声心动图评估重度胸椎侧弯患者静息时的心脏结构和功能变化，为围手术期策略提供依据。
这项回顾性队列分析纳入了294例特发性脊柱侧弯（IS）患者，其特征为原发性胸椎曲度且既往无脊柱手术史。该研究包括97例重度脊柱侧弯患者（定义为Cobb角≥90°）和197例Cobb角<90°的患者，后者被归类为非重度脊柱侧弯。收集了所有患者的一般数据，包括年龄、性别、身高、体重、BMI和原发性胸椎曲度特征。根据年龄、性别、Cobb角和曲度方向进行亚组分析。比较了心脏指标，包括结构和功能参数，并评估了重度脊柱侧弯患者Cobb角与心脏指标之间的相关性。
重度脊柱侧弯患者的心脏参数显著降低，包括左心室舒张直径（LVDd）、右心室舒张直径（RVDd）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、射血分数（EF）和缩短分数（FS）（p<0.05）。亚组分析显示，Cobb角≥120°的患者与90-120°的患者相比，LVDd和心脏指数（CI）较低（p<0.05）。胸椎曲度方向对心脏结构或功能没有显著影响（p>0.05）。18岁以上患者的心脏结构参数明显大于年轻患者，尽管心脏功能相似。男性患者的右心尺寸比女性更大。相关性分析表明，Cobb角与LVDd和CI之间呈负相关（p<0.05）。
重度胸椎侧弯在静息时显著影响心脏结构和功能，主要影响左心室尺寸和心脏指数。年龄和性别影响特定的心脏结构参数，但对心脏功能影响有限。术前评估应优先考虑LVDd和CI，以全面评估这些患者的心脏健康状况。原发性胸椎曲度方向对心脏结构或功能没有显著影响。脊柱畸形的严重程度而非曲度方向是其对心脏健康影响的主要决定因素。
