目的:非侵入性左心室(LV)心肌功(MW)的评估可以超越常规超声心动图对心脏收缩力和功效的了解。然而,手术主动脉瓣置换术(AVR)患者的术中数据有限.这项研究的目的是描述这种心室功能评估技术在这些患者中的可行性和术中过程,并将其与常规的二维(2D)和三维(3D)超声心动图测量和应变分析进行比较。
方法:前瞻性观察性研究。
方法:单一大学医院。
方法:25例计划进行孤立性AVR的患者,其术前左和右心室功能得到保留,窦性心律,没有明显的其他心脏瓣膜病或肺动脉高压,和缓的术中过程。
方法:麻醉诱导(T1)后进行经食管超声心动图检查,体外循环终止后(T2),和胸骨闭合后(T3)。在稳定的血流动力学中进行评估,在窦性心律或心房起搏和血管加压药支持下,去甲肾上腺素≤0.1µg/kg/min。
结果:EchoPACv206软件(GEVingmed超声AS,挪威)用于分析2D和3D左心室射血分数(EF),低压全球纵向应变(GLS),LV全球工作指数(GWI),LV全球建设性工作(GCW),LV全局浪费工作(GWW),和LV全球工作效率(GWE)。对所有患者进行心肌工作评估是可行的。尽管2D和3DEF值没有显着差异,AVR后GWI和GCW显着降低(T1vT2,1,647±380mmHg%v1,021±233mmHg%,p<0.001;T1vT2,2,095±433mmHg%v1,402±242mmHg%,p分别<0.001),而GWW保持不变(T1vT2,296mmHg%[IQR178-452)v309mmHg%[IQR255-438),p=0.97)。这导致旁路后直接GWE降低(T1vT2,84%±6%v78%±5%,p<0.001),但手术结束时GWE已经有所改善(T2vT3,78%±5%v81%±5%,p=0.003)。GWI值无明显变化,GCW,或胸骨闭合前后的2D和3DLVEF(T2vT3)。
结论:LVMW分析显示,我们组患者在旁路后的LV工作量减少,常规超声心动图未检测到。这种不断发展的技术为主动脉瓣置换术围手术期的心脏能量学和效率提供了更深入的见解。
OBJECTIVE: Evaluation of
noninvasive left ventricular (LV) myocardial work (MW) enables insights into cardiac contractility and efficacy beyond conventional echocardiography. However, there is limited intraoperative data on patients undergoing surgical aortic valve replacement (AVR). The aim of this study was to describe the feasibility and the intraoperative course of this technique of ventricular function assessment in these patients and compare it to conventional two (2D)- and three-dimensional (3D) echocardiographic measurements and strain analysis.
METHODS: Prospective observational study.
METHODS: Single university hospital.
METHODS: Twenty-five patients scheduled for isolated AVR with preoperative preserved left and right ventricular function, sinus rhythm, without significant other heart valve disease or pulmonary hypertension, and an uneventful intraoperative course.
METHODS: Transesophageal echocardiography was performed after induction of anesthesia (T1), after termination of cardiopulmonary bypass (T2), and after sternal closure (T3). Evaluation was performed in stable hemodynamics, in sinus rhythm or atrial pacing and vasopressor support with norepinephrine ≤ 0.1 µg/kg/min.
RESULTS: EchoPAC v206 software (GE Vingmed Ultrasound AS, Norway) was used for analysis of 2D and 3D LV ejection fraction (EF), LV global longitudinal strain (GLS), LV global work index (GWI), LV global constructive work (GCW), LV global wasted work (GWW), and LV global work efficiency (GWE). Estimation of myocardial work was feasible in all patients. Although there was no significant difference in the values of 2D and 3D EF, GWI and GCW decreased significantly after AVR (T1 v T2, 1,647 ± 380 mmHg% v 1,021 ± 233 mmHg%, p < 0.001; T1 v T2, 2,095 ± 433 mmHg% v 1,402 ± 242 mmHg%, p < 0.001, respectively), while GWW remained unchanged (T1 v T2, 296 mmHg% [IQR 178-452) v 309 mmHg% [IQR 255-438), p = 0.97). This resulted in a decreased GWE directly after bypass (T1 v T2, 84% ± 6% v 78% ± 5%, p < 0.001), but GWE already improved at the end of surgery (T2 v T3, 78% ± 5% v 81% ± 5%, p = 0.003). There was no significant change in the values of GWI, GCW, or 2D and 3D LVEF before and after sternal closure (T2 v T3).
CONCLUSIONS: LV MW analysis showed a reduction of LV workload after bypass in our group of patients, which was not detected by conventional echocardiographic measures. This evolving technique provides deeper insights into cardiac energetics and efficiency in the perioperative course of aortic valve replacement surgery.