Predictores clínicos y ecocardiográficos del síndrome de bajo gasto cardiaco en la cirugía valvular cardiaca

Abstract

Objective: To determine the possible clinical and echocardiographic predictors associated with the onset of low cardiacoutput syndrome. Materials and methods: An analytical case–control study was conducted in patients with postoperative low cardiac output syndrome treated at Centro de Cardiología y Cirugía Cardiovascular of Hospital Provincial Docente Saturnino Lora in Santiago de Cuba from January 2019 to December 2021. Both study groups were part of the same population of patientswho underwent a cardiovascular surgery but differed in the fact that, at admission, some suffered from postoperative low cardiac output syndrome and others did not. The dependent variable was the presence of low cardiac output and the independent variables were clinical, hemodynamic and echocardiographic factors. Results: In the series, patients under 65 years of age prevailed in both case and control groups (51.2 % and 73.5 %, respectively). Atrial fibrillation, right ventricular systolic function and perioperative bleeding (p = 0.008) were statistically significant (p < 0.05). Most patients (102 [91.10 %; p = 0.047]) showed a left ventricular ejection fraction (LVEF) > 50 % and a large number of patients (76 [45.24 %; p ≤ 0.05; OR: 2.14]) had undergone emergency surgeries. A logistic regression analysis determined that the clinical and echocardiographic variables, such as age over 65 years, depressed rightventricular function, extracorporeal circulation ≥ 90 minutes and elevated pulmonary artery systolic pressure, had astatistically significant association. The area under the curve (AUC) showed that variables including age, extracorporealcirculation time and perioperative bleeding had predictive capability. Conclusions: It was observed that some clinical and echocardiographic elements, such as age, atrial fibrillation, depressed right ventricular systolic function and emergency surgery, were associated as predictors of low cardiac output syndrome.