Reduced Echocardiographic Inotropy Index after Cardiopulmonary Bypass Is Associated With Complications After Cardiac Surgery: An Institutional Outcomes Study.
Reduced Echocardiographic Inotropy Index after Cardiopulmonary Bypass Is Associated With Complications After Cardiac Surgery: An Institutional Outcomes Study.
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DOI：
10.1053/j.jvca.2021.01.041
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发表时间：
2021-09
影响因子：
2.8
通讯作者：
Engoren MC
中科院分区：
文献类型：
--
作者：
Mathis MR;Duggal NM;Janda AM;Fennema JL;Yang B;Pagani FD;Maile MD;Hofer RE;Jewell ES;Engoren MC
尽管超声心动图和血流动力学监测取得了进展，但在心脏手术期间有效量化左心室功能方面取得的进展有限。包括左心室射血分数（LVEF）和心脏指数在内的传统测量仍然依赖于负荷条件;在动态手术环境中，更复杂的测量仍然不切实际。然而，Smith-Madigan收缩力指数（SMII）和势能动能比（PKR）提供了在心脏手术期间可计算的指标，并可能预测结果。使用超声心动图和血流动力学监测数据，我们旨在计算心肺转流术后的SMII和PKR值，并了解与术后结局的相关性，调整先前确定的风险因素。观察性队列研究。三级护理学术医院。2015年至2016年，189例择期成人心脏外科手术。一个也没有。主要结局为术后死亡率或器官系统并发症（卒中、通气时间延长、重新插管、心脏骤停、急性肾损伤、新发房颤）。校正后，SMII <0.83 W/m2独立预测主要结局（校正比值比2.19，95%置信区间1.08 - 4.42），而PKR、LVEF和心脏指数无相关性。当SMII和PKR纳入EuroSCORE II风险模型时，预测性能得到改善（净重新分类指数改善0.457，p = 0.001），而纳入LVEF和心脏指数的模型显示无改善（0.130，p = 0.318）。我们证明，SMII，而不是PKR，作为衡量心脏功能与主要并发症。我们的数据可以指导更合适的围手术期目标导向治疗的研究，以减少心脏手术后的并发症。
Despite advances in echocardiography and hemodynamic monitoring, limited progress has been made to effectively quantify left ventricular function during cardiac surgery. Traditional measures including left ventricular ejection fraction (LVEF) and cardiac index remain dependent on loading conditions; more complex measures remain impractical in a dynamic surgical setting. However, the Smith-Madigan Inotropy Index (SMII) and potential-to-kinetic energy ratio (PKR) offer promise as measures calculable during cardiac surgery and potentially predictive of outcomes. Using echocardiographic and hemodynamic monitoring data, we aimed to calculate SMII and PKR values after cardiopulmonary bypass, and understand associations with postoperative outcomes, adjusting for previously identified risk factors. Observational cohort study. Tertiary care academic hospital. 189 elective adult cardiac surgical procedures from 2015 to 2016. None. The primary outcome was postoperative mortality or organ system complication (stroke, prolonged ventilation, reintubation, cardiac arrest, acute kidney injury, new-onset atrial fibrillation). After adjustment, SMII <0.83 W/m2 independently predicted the primary outcome (adjusted odds ratio 2.19, 95% confidence interval 1.08–4.42) whereas PKR, LVEF, and cardiac index demonstrated no associations. When SMII and PKR were incorporated into a EuroSCORE II risk model, predictive performance improved (net reclassification index improvement 0.457, p = 0.001) whereas a model incorporating LVEF and cardiac index demonstrated no improvement (0.130, p = 0.318). We demonstrate that SMII, but not PKR, as a measure of cardiac function is associated with major complications. Our data may guide investigations of more suitable perioperative goal-directed therapies to reduce complications following cardiac surgery.
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影响因子：
5.7
作者：
Colquhoun DA;Shanks AM;Kapeles SR;Shah N;Saager L;Vaughn MT;Buehler K;Burns ML;Tremper KK;Freundlich RE;Aziz M;Kheterpal S;Mathis MR
通讯作者：
Mathis MR
影响因子：
9.7
作者：
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通讯作者：
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DOI：
10.1016/0735-1097(94)90527-4
发表时间：
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影响因子：
24
作者：
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通讯作者：
PINSKY, MR
影响因子：
2.5
作者：
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通讯作者：
Smith, Brendan E.
DOI：
10.1016/j.jtcvs.2019.03.135
发表时间：
2020-05-01
影响因子：
6
作者：
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通讯作者：
Isbell, James M.