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Qin X, Dan Y, Wang H, Sun L, Ji W, Bai J, Mamtili I, Zhang K, Zheng J. Effect of Ciprofol on Left Ventricular Myocardial Strain and Myocardial Work in Children Undergoing Cardiac Surgery: A Single-center Double-blind Randomized Noninferiority Study. J Cardiothorac Vasc Anesth 2024; 38:2341-2348. [PMID: 38908938 DOI: 10.1053/j.jvca.2024.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/12/2024] [Accepted: 05/29/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE The current work was designed to compare the effects of ciprofol and propofol on left ventricular systolic function and myocardial work by noninvasive speckle-tracking echocardiography in children undergoing surgical repair of atrial septal or ventricular septal defects. DESIGN A single-center double-blind randomized noninferiority study was conducted. SETTING The research occurred at a tertiary care center affiliated with Shanghai Jiao Tong University, China. PARTICIPANTS One hundred and twelve children aged 1 month to 16 years undergoing atrial septal or ventricular septal defect surgery with cardiopulmonary bypass were included. INTERVENTIONS One hundred and twelve children were allocated randomly to receive ciprofol (n = 67) or propofol (n = 45) in a 1.5:1 ratio. Ciprofol or propofol were intravenously infused at loading doses of 0.4 mg/kg or 2.0 mg/kg, respectively, over 30 seconds, depending on the physical condition of each patient. When the bispectral index was maintained between 45 and 55 after induction, transthoracic echocardiography, including apical two-chamber, three-chamber, and four-chamber views, were collected bedside. MEASUREMENTS AND MAIN RESULTS Of the 112 patients enrolled, 104 completed the study. Global longitudinal strain in the ciprofol and propofol groups after anesthesia was -17.3% (95% confidence interval [CI] -18.0% to -16.6%) and -17.8% (95% CI -18.7 to -17.0%) in the full analysis set and -17.5% (95% CI -18.2% to -16.9%) and -17.8% (95% CI -18.7% to -17.0%) in the per-protocol set, respectively. The noninferiority margin was set at 2% and confirmed with a lower limit of two-sided 95% CI for the intergroup difference of 1.58% in the full analysis set and 1.34% in the per-protocol set. There were no significant differences between the groups in left ventricular systolic and diastolic function and myocardial work indices. Postoperative vasoactive-inotropic score, NT-proBNP, duration of mechanical ventilation, and the length of stay in the cardiac intensive care unit and hospital were also comparable between the two groups (all p > 0.05). CONCLUSIONS Ciprofol did not show different effects on myocardial function and postoperative outcomes from propofol. Further, on the sensitive cardiac systole marker global longitudinal strain, ciprofol demonstrated noninferiority to propofol. Ciprofol might be an alternative solution for cardiac anesthesia in children with congestive heart disease with mild lesion.
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Affiliation(s)
- Xiaoxue Qin
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China; Department of Anesthesiology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yingzhi Dan
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China
| | | | - Liping Sun
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China
| | - Wei Ji
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China
| | - Jie Bai
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China; Department of Anesthesiology, Shanghai Children's Medical Center Hainan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ilyar Mamtili
- Department of Anesthesiology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Kan Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China; Department of Anesthesiology, Shanghai Children's Medical Center Hainan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China.
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Costescu A, Riendeau Beaulac G, Guensch DP, Lalancette JS, Couture P, Denault AY. Perioperative echocardiographic strain analysis: what anesthesiologists should know. Can J Anaesth 2024; 71:650-670. [PMID: 38600285 DOI: 10.1007/s12630-024-02713-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/26/2023] [Accepted: 10/28/2023] [Indexed: 04/12/2024] Open
Abstract
PURPOSE Echocardiographic strain analysis by speckle tracking allows assessment of myocardial deformation during the cardiac cycle. Its clinical applications have significantly expanded over the last two decades as a sensitive marker of myocardial dysfunction with important diagnostic and prognostic values. Strain analysis has the potential to become a routine part of the perioperative echocardiographic examination for most anesthesiologist-echocardiographers but its exact role in the perioperative setting is still being defined. CLINICAL FEATURES This clinical report reviews the principles underlying strain analysis and describes its main clinical uses pertinent to the field of anesthesiology and perioperative medicine. Strain for assessment of left and right ventricular function as well as atrial strain is described. We also discuss the potential role of strain to aid in perioperative risk stratification, surgical patient selection in cardiac surgery, and guidance of anesthetic monitor choice and clinical decision-making in the perioperative period. CONCLUSION Echocardiographic strain analysis is a powerful tool that allows seeing what conventional 2D imaging sometimes fails to reveal. It often provides pathophysiologic insight into various cardiac diseases at an early stage. Strain analysis is readily feasible and reproducible thanks to the use of highly automated software platforms. This technique shows promising potential to become a valuable tool in the arsenal of the anesthesiologist-echocardiographer and aid in perioperative risk-stratification and clinical decision-making.
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Affiliation(s)
- Adrian Costescu
- Department of Anesthesiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Geneviève Riendeau Beaulac
- Department of Anesthesiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Dominik P Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jean-Simon Lalancette
- Division of Critical Care, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Pierre Couture
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - André Y Denault
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.
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Liao H, Yang S, Yu S, Hu X, Meng X, Wu K. Prognostic Value of Left Ventricular Global Longitudinal Strain for Major Adverse Cardiovascular Events in Patients with Aortic Valve Disease: A Meta-Analysis. Cardiology 2024; 149:277-285. [PMID: 38301616 DOI: 10.1159/000536331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Valvular heart disease is one of the most common heart diseases. It is characterized by abnormal function or structure of the heart valves. There may be no clinical symptoms in the early stages. Clinical symptoms of arrhythmia, heart failure, or thromboembolic events may occur in the late stages of the disease, such as palpitation after activities, breathing difficulties, fatigue, and so on. Aortic valve disease is a major part of valvular heart disease. The main treatment for aortic valve disease is valve replacement or repair surgery, but it is extremely risky. Therefore, a rigorous prognostic assessment is extremely important for patients with aortic valve disease. The global longitudinal strain is an index that describes the deformation capacity of myocardium. There is evidence that it provides a test for systolic dysfunction other than LVEF (left ventricular ejection fraction) and provides additional prognostic information. METHOD Search literature published between 2010 and 2023 on relevant platforms and contain the following keywords: "Aortic valve disease," "Aortic stenosis," "Aortic regurgitation," and "longitudinal strain" or "strain." The data is then extracted and collated for analysis. RESULTS A total of 15 articles were included. The total population involved in this study was 3,678 individuals. The absolute value of LVGLS was higher in the no-MACE group than in the MACE group in patients with aortic stenosis (Z = 8.10, p < 0.00001), and impaired LVGLS was a risk factor for MACE in patients with aortic stenosis (HR = 1.14, p < 0.00001, 95% CI: 1.08-1.20). There was also a correlation between impaired LVGLS and aortic valve surgery in patients with aortic valve disease (HR = 1.16, p < 0.0001, 95% CI: 1.08-1.25) or patients with aortic valve regurgitation (HR = 1.21, p = 0.0004, 95% CI: 1.09-1.34). We also found that impaired LVGLS had no significant association between LVGLS and mortality during the period of follow-up in patients with aortic valve stenosis (HR = 1.08, 95% CI: 0.94-1.25, p = 0.28), but it was associated with mortality in studies of prospective analyses (HR = 1.34, 95% CI: 1.02-1.75, p = 0.04). CONCLUSIONS Impaired LVGLS correlates with major adverse cardiovascular events in patients with aortic valve disease, and it has predictive value for the prognosis of patients with aortic valve disease.
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Affiliation(s)
- Hongsheng Liao
- Graduate School, Guizhou Medical University, Guiyang, China,
| | - Siyuan Yang
- Department of Cardiovascular Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Shaomei Yu
- Ultrasound Center, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xuanyi Hu
- Department of Cardiovascular Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - XiongWei Meng
- Department of Cardiovascular Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Kui Wu
- Department of Cardiovascular Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Wakefield BJ, Artis AS, Alfirevic A, Sale S, Duncan AE. Post-cardiopulmonary bypass longitudinal strain provides higher prognostic ability than baseline strain or change in strain. Ann Card Anaesth 2022; 25:505-513. [PMID: 36254918 PMCID: PMC9732967 DOI: 10.4103/aca.aca_295_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 04/20/2021] [Accepted: 05/18/2021] [Indexed: 06/16/2023] Open
Abstract
CONTEXT Global longitudinal strain (GLS) measured by speckle-tracking echocardiography demonstrates excellent prognostic ability in predicting major adverse cardiac events after cardiac surgery. However, the optimal timing of intraoperative GLS measurement that provides the best prognostic value is unclear. AIM Our goal was to evaluate whether GLS measured prior to cardiopulmonary bypass (pre-CPB GLS), following CPB (post-CPB GLS), or change in GLS provides the strongest association with postoperative complications. SETTING AND DESIGN Post hoc analysis of prospectively collected data from a clinical trial (NCT01187329). 72 patients with aortic stenosis undergoing elective AVR ± coronary artery bypass grafting between January 2011 and August 2013. MATERIAL AND METHODS Myocardial deformation analysis from standardized transesophageal echocardiographic examinations were performed after anesthetic induction and chest closure. We evaluated the association between pre-CPB GLS, post-CPB GLS, and change in GLS (percent change from pre-CPB baseline) with postoperative atrial fibrillation and hospitalization >7 days. The association of post-CPB GLS with duration of mechanical ventilation, N-terminal pro-BNP (NT-proBNP) and troponin T were also assessed. STATISTICAL ANALYSIS Multivariable logistic regression. RESULTS Risk-adjusted odds (OR[97.5%CI] of prolonged hospitalization increased an estimated 27% (1.27[1.01 to 1.59];Padj =0.035) per 1% decrease in absolute post-CPB GLS. Mean[98.3%CI] NT-proBNP increased 98.4[20 to 177]pg/mL; Padj =0.008), per 1% decrease in post-CPB GLS. Pre-CPB GLS or change in GLS were not associated with any outcomes. CONCLUSIONS Post-CPB GLS provides the best prognostic value in predicting postoperative outcomes. Measuring post-CPB GLS may improve risk stratification and assist in future study design and patient outcome research.
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Affiliation(s)
- Brett J. Wakefield
- Department of Intensive Care and Resuscitation, Cardiothoracic Anesthesiology, and Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Amanda S. Artis
- Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Andrej Alfirevic
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Shiva Sale
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Andra E. Duncan
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
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Traunero K, Gartman C, Patel SJ, Augoustides JG. Global Left Ventricular Strain: Exciting Applications In Perioperative Practice. J Cardiothorac Vasc Anesth 2021; 36:175-177. [PMID: 34801394 DOI: 10.1053/j.jvca.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Kelsey Traunero
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA
| | - Charles Gartman
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA
| | - Saumil J Patel
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA.
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Borde D, Joshi P, Asegaonkar B, Agrawal A. Perioperative Changes in Global Myocardial Work Indices in a Patient With Severe Aortic Stenosis With Severe Left Ventricular Dysfunction Undergoing Surgical Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2021; 36:2060-2065. [PMID: 34389212 DOI: 10.1053/j.jvca.2021.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/11/2021] [Accepted: 07/19/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Deepak Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
| | - Pooja Joshi
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Balaji Asegaonkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Ashish Agrawal
- Department of Cardiac Surgery, Seth Nandlal Dhoot Hospital, Aurangabad, Maharashtra, India
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Benson MJ, Silverton N, Morrissey C, Zimmerman J. Strain Imaging: An Everyday Tool for the Perioperative Echocardiographer. J Cardiothorac Vasc Anesth 2020; 34:2707-2717. [DOI: 10.1053/j.jvca.2019.11.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/17/2019] [Accepted: 11/24/2019] [Indexed: 11/11/2022]
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Rong LQ, Neuburger PJ, Kim J, Devereux RB. Left ventricular global longitudinal strain and cardiac surgical outcomes. Minerva Cardioangiol 2020; 68:489-496. [PMID: 32472988 DOI: 10.23736/s0026-4725.20.05251-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Global longitudinal strain (GLS) has emerged as a valuable diagnostic and prognostic tool for evaluating left ventricular (LV) function. GLS has been shown to be a more sensitive marker of LV dysfunction than LV ejection fraction alone and have prognostic impact in non-surgical cardiac populations. GLS, is validated, reproducible, and easily obtained from 2-dimensional speckle-tracking echocardiography. While there is strong evidence for using GLS in clinical decision-making in non-surgical populations, there is less summarized evidence on using GLS in the cardiac surgical population. This review combines the evidence on the implications of using baseline transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) GLS in cardiac surgical populations including ischemic and structural heart disease to determine surgical outcomes. We found that results seem promising on the prognostic utility of LV strain in cardiac surgical populations. However due to the variability of study populations and outcomes, and modalities (TTE versus TEE), further research on normal versus abnormal values for different surgical populations, as well potential treatment options that may modify and potentially decrease surgical risk for those with abnormal GLS are needed.
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Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA -
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Langone Medical Center, New York, NY, USA
| | - Jiwon Kim
- Department of Cardiology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Richard B Devereux
- Department of Cardiology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
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Shahidi-Dadras M, Pishgahi M, Tabary M, Kheradmand Z, Araghi F, Dadkhahfar S, Robati RM. Cardiac function in pemphigus vulgaris patients before and after steroid pulse therapy. J DERMATOL TREAT 2019; 32:855-859. [PMID: 31868046 DOI: 10.1080/09546634.2019.1708850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pemphigus vulgaris which is an autoimmune dermatological disorder characterized by vesiculobullous lesions over the skin and mucosae may also give rise to cardiac disease. Global Longitudinal Strain (GLS) measurement may help to predict cardiac dysfunction in these patients. METHOD In this prospective study, the GLS was measured before and after steroid pulse therapy in pemphigus vulgaris patients using 2 D speckle-tracking echocardiography. Moreover, blood pressure, pulse rate, and corrected QT (cQT) interval were recorded before and after steroid pulse therapy. RESULTS We included 23 pemphigus patients. The mean age of patients was 34.5(±6.4). Mean GLS decreased significantly after the administration of steroid pulse therapy. The mean GLS decreased regardless of age, however, the patients with the age range of 40-50 years showed the highest change in GLS. There was no interaction between gender and GLS change. Mean cQT increased significantly after pulse therapy (p=.007). Heart rate increased significantly from 88.5 ± 10.8 to 97.0 ± 13.4 (p<.001). Mean systolic and diastolic blood pressure did not show any significant change. CONCLUSIONS The steroid pulse therapy may associate with the progression of cardiac dysfunction in pemphigus patients. GLS, as a predictor, may be a valuable marker of cardiac subclinical dysfunction in this condition.
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Affiliation(s)
| | - Mehdi Pishgahi
- Department of Cardiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Zohreh Kheradmand
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farnaz Araghi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza M Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abuelkasem E, Wang DW, Subramaniam K. Pro: Myocardial Deformation Imaging Should Be Used Perioperatively for Assessment of Cardiac Function. J Cardiothorac Vasc Anesth 2019; 33:3196-3200. [DOI: 10.1053/j.jvca.2019.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/28/2019] [Accepted: 05/06/2019] [Indexed: 11/11/2022]
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Abuelkasem E, Wang DW, Omer MA, Abdelmoneim SS, Howard-Quijano K, Rakesh H, Subramaniam K. Perioperative clinical utility of myocardial deformation imaging: a narrative review. Br J Anaesth 2019; 123:408-420. [DOI: 10.1016/j.bja.2019.04.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/09/2019] [Accepted: 04/28/2019] [Indexed: 01/25/2023] Open
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Speckle Tracking Strain Echocardiography: On Its Way into the Operating Room. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00342-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zhang K, Sheu R, Zimmerman NM, Alfirevic A, Sale S, Gillinov AM, Duncan AE. A Comparison of Global Longitudinal, Circumferential, and Radial Strain to Predict Outcomes After Cardiac Surgery. J Cardiothorac Vasc Anesth 2018; 33:1315-1322. [PMID: 30581109 DOI: 10.1053/j.jvca.2018.10.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Myocardial strain measured by speckle-tracking echocardiography detects subtle regional and global left ventricular dysfunction. Myocardial strain is measured in the longitudinal, circumferential, and radial dimensions; however, it is unclear which dimension of strain is the best predictor of postoperative outcomes. DESIGN A secondary analysis of prospectively collected data from a clinical trial (NCT01187329). SETTING The cardiothoracic surgical operating rooms of an academic tertiary-care center. PARTICIPANTS Cardiothoracic surgery patients with aortic stenosis having aortic valve replacement (AVR) with or without coronary artery bypass grafting enrolled in a clinical trial. INTERVENTIONS Myocardial deformation analysis from standardized investigative transesophageal echocardiographic examinations performed after induction of anesthesia. MEASUREMENTS AND MAIN RESULTS The authors compared the ability of intraoperative global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) strain to predict adverse postoperative outcomes, including prolonged hospitalization and the need for pharmacologic hemodynamic support after cardiac surgery. The association of GLS, GCS, and GRS with prolonged hospitalization (>7 days) and the need for pharmacologic hemodynamic support, with epinephrine or norepinephrine after cardiopulmonary bypass, were assessed using separate multivariable logistic regression models with adjustment for multiple comparisons. Of 100 patients, 86 had acceptable measurements for GLS analysis, 73 for GCS, and 72 for GRS. Worse GLS was associated with prolonged hospitalization [odds ratio [OR] (98.3% confidence interval [CI]) of 1.21 (1.01-1.46) per-unit worsening in strain (p = 0.01, significance criterion <0.0167)] and the need for inotropic support with epinephrine [OR (99.2% CI) of 1.81 (1.10-2.97) per-unit worsening in strain (p = 0.002, significance criterion <0.0083)], but not norepinephrine. GCS and GRS were not associated with adverse outcomes. CONCLUSION GLS, but not GCS or GRS, predicts prolonged hospitalization and the requirement for inotropic support with epinephrine after AVR.
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Affiliation(s)
- Kan Zhang
- Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - Richard Sheu
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA
| | - Nicole M Zimmerman
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH
| | - Andrej Alfirevic
- Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH
| | - Shiva Sale
- Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH
| | - Andra E Duncan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH; Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH.
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Howard-Quijano K, Zhang K, Skubas NJ. Strain as an Outcome Predictor. Anesth Analg 2018; 126:1453-1454. [PMID: 29672386 DOI: 10.1213/ane.0000000000002910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Kimberly Howard-Quijano
- From the Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
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