Left and right ventricular diastolic dysfunction as predictors of difficult separation from cardiopulmonary bypass
Left and right ventricular diastolic dysfunction as predictors of difficult separation from cardiopulmonary bypass
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DOI：
10.1007/bf03022532
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发表时间：
2006-10-01
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影响因子：
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通讯作者：
Tardif, Jean-Claude
中科院分区：
文献类型：
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作者：
Denault, Andre Y.;Couture, Pierre;Tardif, Jean-Claude
目的：由于在忙碌的心脏手术室中，舒张功能的评估可能很复杂，因此使用经食管超声心动图的算法方法可能会对其进行评估。我们开发了一种诊断算法，然后将其应用于一系列心脏手术患者，以确定中度至重度左心室舒张功能障碍（LVDD）和右心室舒张功能障碍（RVDD）是否可以预测心肺转流（DSB）分离困难。使用二尖瓣和三尖瓣、肺静脉和肝静脉血流的脉冲波多普勒询问的算法，并开发了二尖瓣和三尖瓣环的组织多普勒询问。该研究分为两个阶段，涉及两组接受心脏手术的患者。在第一阶段，使用患者（n = 74）的超声心动图评价来测试算法的再现性，并使用在三个特定时期计算的Cohen kappa值来评价观察者间的变异性。在第11阶段，将该算法应用于第二组患者（验证组，n = 179），以探讨其预后意义。第11阶段的主要终点是DSB。结果：在第1阶段，LVDD和RVDD算法的Kappa系数分别为0.77和0.82。在II期，心脏手术前，29例患者（16%）观察到中度或重度LVDD，18例患者（10%）观察到中度至重度RVDD。DSB患者术前中、重度LVDD（P = 0.017）和RVDD（P = 0.049）发生率较高。结论：中、重度LVDD和RVDD可重复性很好地鉴别，两种舒张功能障碍程度均与DSB相关。
Purpose: As the evaluation of diastolic function can be complex in the setting of a busy cardiac operating room, its assessment may benefit from an algorithmic approach using transesophageal echocardiography. We developed a diagnostic algorithm which was then applied in a series of cardiac surgery patients to determine whether moderate to severe left ventricular diastolic dysfunction (LVDD) and right ventricular diastolic dysfunction (RVDD) can predict difficult separation from cardiopulmonary bypass (DSB).Methods: An algorithm using pulsed-wave Doppler interrogation of the mitral and tricuspid valve, the pulmonary and hepatic venous flow, and tissue Doppler interrogation of the mitral and tricuspid annulus was developed. The study was divided in two phases involving two groups of patients undergoing cardiac surgery In phase I, echocardiographic evaluations of patients (n = 74) were used to test the reproducibility of the algorithm and to evaluate inter-observer variability using Cohen's kappa values which were calculated in three specific periods. In phase 11, the algorithm was applied to a second group of patients (validation group, n = 179) to explore its prognostic significance. The primary end-point in phase 11 was DSB.Results: In phase 1, the kappa coefficients for LVDD and RVDD algorithms were 0.77 and 0.82, respectively. In phase II, moderate or severe degrees of LVDD were observed in 29 patients (16%) and moderate to severe RVDD was observed in 18 patients (10%) before cardiac surgery. Both moderate and severe LVDD (P = 0.017) and RVDD (P = 0.049) before surgery were observed more frequently in patients with DSB.Conclusion: Moderate and severe LVDD and RVDD can be identified with very good reproducibility, and both degrees of diastolic dysfunction are associated with DSB.