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Russo A, Bergamini Viola E, Gambaro A, Di Gennaro G, Fanti D, Devigili A, Ceola Graziadei M, Brognoli G, Corubolo L, Rama J, Zanin A, Schweiger V, Donadello K, Polati E, Gottin L. Preoperative right ventricular strain as an early predictor of perioperative cardiac failure in patients undergoing mitral surgery: An exploratory study. Health Sci Rep 2024; 7:e2172. [PMID: 39050905 PMCID: PMC11265990 DOI: 10.1002/hsr2.2172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/14/2024] [Accepted: 05/22/2024] [Indexed: 07/27/2024] Open
Abstract
Objectives This study's primary purpose was to demonstrate the correlation of preoperative right ventricular free-wall longitudinal strain (RVFWLS) and pre-/postsurgical variation in strain (delta strain) with the clinical and echocardiographic diagnosis of right ventricular dysfunction. Its secondary purpose was to determine the correlation of RVFWLS and delta strain with length of stay (LOS) in the intensive care unit (ICU), ventilation days, trend of natriuretic peptide test. (NT-proBNP) and lactate in the first 48 h, incidence of acute renal failure, and 28-day mortality. Design Prospective observational study. Setting Cardio-thoracic and Vascular Anaesthesia Department and ICU of the University Hospital Integrated Trust of Verona. Participants Patients scheduled for mitral surgery. Interventions None. Measurements and Main Results All clinical and transoesophageal echocardiographic (TEE) parameters were collected at baseline, before surgery (T1) and at admission in the ICU postsurgery (T2). During the postoperative period, the clinical and echocardiographic diagnoses of right, left, or biventricular dysfunction were evaluated. TEE parameters were evaluated by a cardiologist offline. The patients were divided into two subgroups according to the development of any type of ventricular dysfunction. No statistically significant differences emerged between the two groups. According to a logistic regression model, a T1-RVFWLS value of -15% appeared to predict biventricular dysfunction (sensitivity: 100%; specificity: 91.3%). No correlation between T1- or T2-RVFWLS and creatinine, hours of ventilation or ICU LOS was found. Conclusions Our study introduces a new parameter that could be used in perioperative evaluations to identify patients at risk of postoperative biventricular dysfunction.
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Affiliation(s)
- Alessandro Russo
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Elisa Bergamini Viola
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Alessia Gambaro
- Department of Medicine, Cardiology Division, University Hospital Integrated Trust of VeronaUniversity of VeronaVeronaItaly
| | - Gianfranco Di Gennaro
- Department of Health Sciences, Medical StatisticsUniversity of Magna GraeciaCatanzaroItaly
| | - Diego Fanti
- Department of Medicine, Cardiology Division, University Hospital Integrated Trust of VeronaUniversity of VeronaVeronaItaly
| | - Alessandro Devigili
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Marcello Ceola Graziadei
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Gabriele Brognoli
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Luisa Corubolo
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Jacopo Rama
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Anita Zanin
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Vittorio Schweiger
- Anaesthesia and Intensive Care B Unit, AOUI‑University Hospital Integrated Trust of VeronaUniversity of VeronaVeronaItaly
| | - Katia Donadello
- Anaesthesia and Intensive Care B Unit, AOUI‑University Hospital Integrated Trust of VeronaUniversity of VeronaVeronaItaly
| | - Enrico Polati
- Anaesthesia and Intensive Care B Unit, AOUI‑University Hospital Integrated Trust of VeronaUniversity of VeronaVeronaItaly
| | - Leonardo Gottin
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
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Pastore MC, Vannuccini F, Mandoli GE, Lisi M, Iuliano MA, Santoro A, Niglio FP, Diviggiano EE, Lorenz V, Montesi G, Cavigli L, Focardi M, D'Ascenzi F, Cameli M. Myocardial work and left heart deformation parameters across primary mitral regurgitation severity. Int J Cardiol 2024; 399:131772. [PMID: 38211675 DOI: 10.1016/j.ijcard.2024.131772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/22/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
AIMS Myocardial work (MW) estimation by pressure-strain loops using speckle tracking echocardiography (STE) has shown to evaluate left ventricular (LV) contraction overcoming the load-dependency limit of LV global longitudinal strain (GLS). This has proved useful in hemodynamic variation settings e.g. heart failure and valvular heart disease. However, the variation of MW and strain parameters across different stages of primary mitral regurgitation (MR) and its impact on symptoms, which was the aim of our study, has never been investigated. METHODS AND RESULTS Consecutive patients with mild, moderate and severe MR were prospectively enrolled. Exclusion criteria were: chronic atrial fibrillation, valvular heart prosthesis, previous cardiac surgery. Clinical evaluation, blood sample tests, ECG and echocardiography with STE and MW measurement were performed. Patients were then divided into groups according to MR severity. Differences among the groups and predictors of symptoms (as NYHA class≥2) were explored as study endpoints. Overall, 180 patients were enrolled (60 mild,60 moderate,60 severe MR). LV GLS and global peak atrial longitudinal strain (PALS) reduced according to MR severity. Global constructive work (GCW) and global wasted work (GWW) significantly improved, while global work efficiency (GWE) reduced, in patients with moderate and severe MR. Among echocardiographic parameters, global PALS emerged as the best predictor of NYHA class (p < 0.001;area under curve,AUC = 0.7). CONCLUSIONS MW parameters accurately describe the pathophysiology of MR, with initial attempt of LV increased contractility to compensate volume overload parallel to the disease progress, although with low efficacy, while global PALS is the most associated with the burden of MR symptoms.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | - Francesca Vannuccini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Lisi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Alma Iuliano
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Alfonso Santoro
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesco Paolo Niglio
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Enrico Emilio Diviggiano
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Veronica Lorenz
- Division of Cardio-Thoracic Surgery, Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Gianfranco Montesi
- Division of Cardio-Thoracic Surgery, Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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