Left ventricular strain is associated with acute postoperative refractory hypotension in patients with constrictive pericarditis and preserved ejection fraction
Left ventricular strain is associated with acute postoperative refractory hypotension in patients with constrictive pericarditis and preserved ejection fraction
复制标题
左心室应变与射血分数保留的缩窄性心包炎患者术后急性难治性低血压相关
DOI：
10.21037/jtd.2018.06.124
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发表时间：
2018-07-01
影响因子：
2.5
通讯作者：
Fang, Li-Gang
中科院分区：
文献类型：
--
作者：
Wang, Fang-Fei;Hsu, Jeffrey;Fang, Li-Gang
背景：心包切除术是治疗缩窄性心包炎（CP）的有效方法。术后早期并发症，如顽固性低血压和充血性心力衰竭发生在这些患者中，并与发病率和死亡率增加有关。我们假设二维斑点跟踪超声心动图（2DSTE）测量的左心室（LV）心肌应变可以识别早期心功能障碍，并与CP患者的急性术后不良事件有关。方法：纳入44例左室射血分数（LVpEF）保留的CP患者（64%±8%）和44例年龄和性别匹配的对照组。心包切除术前行常规2DSTE。测量了整体和局部峰值收缩应变值。主要终点是术后难治性低血压、充血性心力衰竭和心源性死亡。难治性低血压定义为需要长时间静脉使用肌力药物（IVIM）的低血压（>= 2天）。结果：术后出现难治性低血压26例，无一例发生充血性心力衰竭和心源性死亡。与对照组相比，CP患者的绝对整体和节段周向应变（CS）、径向应变（RS）和纵向应变（LS）（间隔LS除外）均降低。难治性低血压患者心外膜CS较低（P=0.04）。心外膜CS是与术后不良结局相关的独立危险因素[P=0.014, OR =1.236(1.044-1.464)]，而LVEF与之无关。心外膜CS绝对值越低，围手术期静脉滴注速尿维持负体液平衡的时间越长（P=0.04），静脉滴注速尿维持负体液平衡的时间越长（P=0.02）。结论：CP合并LVpEF患者左室应变值明显降低。术前较低的心外膜CS值与早期难治性低血压和更积极的液体处理的高风险相关。
Background: Pericardiectomy is an effective treatment for constrictive pericarditis (CP). Early postoperative complications such as refractory hypotension and congestive heart failure occur in these patients and arc associated with increased morbidity and mortality. We hypothesized that left ventricular (LV) myocardial strain measured by two-dimensional speckle tracking echocardiography (2DSTE) could identify early cardiac dysfunction and relate to acute postoperative adverse events in CP patients.Method: Forty-four CP patients with preserved left ventricular ejection fraction (LVpEF, (64%+/- 8%) and 44 age- and sex-matched controls were enrolled. Conventional 2DSTE was performed before pericardiectomy. Global and segmental peak systolic strain values were measured. The primary endpoint was a composite of postoperative refractory hypotension, congestive heart failure and cardiogenic death. Refractory hypotension was defined as hypotension requiring prolonged usage of intravenous inotropic medication (IVIM) (>= 2 days).Results: Postoperative refractory hypotension occurred in 26 cases, and no patients experienced congestive heart failure or cardiogenic death. Compared to controls, CP patients had decreased absolute global and segmental circumferential strain (CS), radial strain (RS), and longitudinal strain (LS) except septal LS. Patients with refractory hypotension exhibited lower epicardial CS (P=0.04). Epicardial CS was an independent risk factor correlated with postoperative adverse outcome [P=0.014, OR =1.236 (1.044-1.464)] while LVEF was not. Lower absolute value of epicardial CS was related to higher (P=0.02) and longer usage of intravenous furosemide (P=0.04) to keep negative fluid balance perioperatively.Conclusions: LV strain value is markedly reduced in patients with CP and LVpEF. Lower preoperative epicardial CS value is associated with greater risk of early refractory hypotension and more aggressive fluid management.