Comparison of early postoperative left ventricular function with 3d ef and strain measurements according to graft selection.

IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiothoracic Surgery Pub Date : 2024-10-29 DOI:10.1186/s13019-024-03043-9
Ozan Erturk, Nursen Keles, Anıl Karaagac, Aylin Safak Arslanhan, Yusuf Kagan Pocan, Mehmet Inanc Yesilkaya, Burak Bozkurt, Hakkı Aydogan, Mehmet Kaplan
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Abstract

Background: Graft choices other than left anterior descending artery (LAD)-internal thoracic artery (ITA) anastomosis in coronary artery bypass grafting (CABG) surgery are still controversial. Although 2-dimensional transthoracic echocardiography (2D TTE) is still the most commonly used method, more is needed to diagnose myocardial dysfunction. Ventricular strain values obtained by speckle tracking echocardiography (STE) or tissue Doppler imaging (TDI) methods can much better detect subclinical changes. This study aims to detect early postoperative myocardial function changes compared to single ITA/Bilateral Internal Thoracic Artery (BITA) use by measuring 3-dimensional ejection fraction (3D EF) and ventricular strain values and comparing them according to graft preference.

Methods: The study included 35 isolated CABG patients. All patients underwent on-pump CABG via sternotomy. The patients were divided into two groups using single ITA and BITA. Preoperative and postoperative 1st-week 3D EF and ventricular strain values of the patients were calculated using semi-automatic software. The recorded data were compared and evaluated between the two groups.

Results: Of The 35 patients participating in the study, 74.3% (n = 26) were male, 25.7% (n = 9) were female, and their average age was 62.7 ± 7.9 years. Preoperative 3D EF values of the patients were 54.4 ± 8.3% and postoperative 49.5 ± 8.2%. The mean preoperative Apical Long Axis Longitudinal Strain (APLAX LS) was calculated as - 16.2 ± 5.0%, 4 Chambers Longitudinal Strain (4CH LS)-16.8 ± 4.6%, 2 Chambers Longitudinal Strain (2CH LS) - 17.0 ± 4.9%, and Global Longitudinal Ventricular Strain (GLVS) - 16.7 ± 4.2%. Postoperative strain values were measured as - 15.1 ± 4.8%, - 14.7 ± 4.9%, - 14.6 ± 5.6% and - 14.8 ± 4.6%, respectively. When the groups were evaluated within themselves, the mean preoperative 3D EF of the patients in the single ITA group was 52.5 ± 8.8%, while the postoperative mean was 47.7 ± 6.0%. In the BITA group, preoperative 3D EF was 56.3 ± 7.5 and postoperative 51.4 ± 9.8. A decrease in strain values was detected in all groups except APLAX planes.

Conclusions: In our study, no statistically significant difference was observed in terms of myocardial function changes according to the use of ITA/BITA. However, the decline in postoperative strain values of patients in the BITA group was more remarkable, and it was thought that this may be due to prolonged aortic cross clamp (CC) and cardiopulmonary bypass (CPB) times.

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根据移植物的选择,比较术后早期左心室功能与 3D EF 和应变测量值。
背景:在冠状动脉旁路移植手术(CABG)中,除左前降支动脉(LAD)-胸内动脉(ITA)吻合术外,其他移植方式的选择仍存在争议。虽然二维经胸超声心动图(2D TTE)仍是最常用的方法,但诊断心肌功能障碍还需要更多的方法。通过斑点追踪超声心动图(STE)或组织多普勒成像(TDI)方法获得的心室应变值能更好地检测亚临床变化。本研究旨在通过测量三维射血分数(3D EF)和心室应变值,并根据移植物偏好进行比较,检测与使用单一 ITA/双侧胸内动脉(BITA)相比的术后早期心肌功能变化:研究包括 35 例孤立 CABG 患者。所有患者均通过胸骨切开术接受了体外泵 CABG。患者被分为使用单ITA和BITA的两组。使用半自动软件计算患者术前和术后第一周的三维 EF 值和心室应变值。对两组记录的数据进行比较和评估:参与研究的 35 名患者中,74.3%(n = 26)为男性,25.7%(n = 9)为女性,平均年龄为 62.7 ± 7.9 岁。患者术前的三维 EF 值为 54.4 ± 8.3%,术后为 49.5 ± 8.2%。术前心尖长轴纵向应变(APLAX LS)的平均值为(16.2 ± 5.0%),4腔室纵向应变(4CH LS)为(16.8 ± 4.6%),2腔室纵向应变(2CH LS)为(17.0 ± 4.9%),心室整体纵向应变(GLVS)为(16.7 ± 4.2%)。术后应变值分别为 - 15.1 ± 4.8%、- 14.7 ± 4.9%、- 14.6 ± 5.6% 和 - 14.8 ± 4.6%。在对各组进行内部评估时,单ITA组患者术前的平均三维EF值为(52.5 ± 8.8)%,而术后的平均值为(47.7 ± 6.0)%。在 BITA 组中,术前三维 EF 为 56.3 ± 7.5,术后为 51.4 ± 9.8。除 APLAX 平面外,其他各组的应变值均有所下降:在我们的研究中,根据ITA/BITA的使用情况,心肌功能的变化在统计学上没有明显差异。然而,BITA 组患者术后应变值的下降更为明显,这可能是由于主动脉交叉钳夹(CC)和心肺旁路(CPB)时间延长所致。
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来源期刊
Journal of Cardiothoracic Surgery
Journal of Cardiothoracic Surgery 医学-心血管系统
CiteScore
2.50
自引率
6.20%
发文量
286
审稿时长
4-8 weeks
期刊介绍: Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields. Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials. Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.
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