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Chen J, Song D, Sun Z, Zhang Y, Zhang L. Effects of lung resection on heart structure and function: A tissue Doppler ultrasound survey of 43 cases. Biomed Rep 2024; 20:11. [PMID: 38124772 PMCID: PMC10731166 DOI: 10.3892/br.2023.1699] [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: 12/11/2022] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
Changes in heart structure and function after lung resection in patients with lung cancer are challenging to manage. Therefore, a non-invasive and reliable measurement tool to gauge such changes is critical. The purpose of the present study was to compare cardiological changes before and after lung resection using tissue Doppler imaging (TDI). A total of 43 patients (19 men and 24 women) with primary non-small cell lung cancer (n=37) and metastatic cancer in the lungs (n=6) were enrolled in the study.nTDI was used to determine the thickness of the ascending aorta, the open size of the ascending valve, the anterior-oposterior diameters of the left atrium and left ventricle, and the thickness of the ventricular septum and right ventricle before and after lung resection. Left ventricular (LV) ejection fraction (EF), pulmonary valve flow rate, tricuspid annular or mitral leaflet tip early (E) peak/late (A) diastolic blood flow velocities, tricuspid regurgitation flow, the lateral mitral annulus early (e') diastolic velocity and mitral E/e' ratio were used to determine LV filling pressure. Results revealed no significant differences between male and female patients in terms of the open size of the ascending valve, the anterior-posterior diameter of the left ventricle and the mitral E/e' ratio. Significant differences were found in the width of the ascending aorta, anterior-posterior diameter of the left atrium, width of the LV septum and right ventricular (RV) diameter before and after lung resection. Finally, there were significantchanges in EF and tricuspid pressure. The results indicated that TDI was useful as a non-invasive method for assessing left and right heart function following lung resection. The LV and RV dimensions were affected, but LV filling pressure was preserved after lobectomy.
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Affiliation(s)
- Jinfeng Chen
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Dongdong Song
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Zhiying Sun
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Yunxiao Zhang
- Department of Anesthesia, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Lijian Zhang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
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TRITAPEPE L, SMERIGLIA A. From anesthetist-intensivist to diastolologist: is this a path to follow? Minerva Anestesiol 2022; 88:878-880. [DOI: 10.23736/s0375-9393.22.16620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ge WD, Li FZ, Hu BC, Wang LH, Ren DY. Factors associated with left ventricular diastolic dysfunction in patients with septic shock. Eur J Med Res 2022; 27:134. [PMID: 35897043 PMCID: PMC9327319 DOI: 10.1186/s40001-022-00761-5] [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: 01/27/2022] [Accepted: 07/10/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To investigate risk factors associated with left ventricular diastolic dysfunction (LVDD) of patients with septic shock. Materials and methods Patients with septic shock concomitant with or without LVDD were retrospectively enrolled and divided into the LVDD group (n = 17) and control without LVDD (n = 85). The clinical and ultrasound data were analyzed. Results A significant (P < 0.05) difference existed between the two groups in serum creatinine, APACHE II score, serum glucose, triglyceride, BUN, FT4, LAVI, mitral E, average e’, E/average e’, septal e’, septal e’/septal s’, E/septal e’, lateral s’, lateral e’, and E/lateral e’. LAVI > 37 mL/m2, septal e’ < 7 cm/s (OR 11.04, 95% CI 3.38–36.05), septal e’/septal s’ < 0.8 (OR 4.09, 95% CI 1.37–12.25), E/septal e’ > 15 (OR 22.86, 95% CI 6.09–85.79), lateral e’ < 8 cm/s (OR 9.16, 95% CI 2.70–31.07), E/lateral e’ > 13 (OR 52, 95% CI 11.99- 225.55), lateral s’ < 10 (OR 3.36, 95% CI 1.13–9.99), average e’ > 10, E/average e’ > 10 (OR 9.53, 95% CI 2.49–36.46), APACHE II score > 16 (OR 3.33, 95% CI 1.00–11.03), SOFA > 5 (or 3.43, 95% CI 1.11–10.60), BUN > 12 mmol/L (OR 3.37, 95% CI 1.15–9.87), serum creatinine > 146 μmol/L (OR 5.08, 95% CI 1.69–15.23), serum glucose > 8 mmol/L (OR 3.36, 95% CI 1.09–10.40), and triglyceride > 1.8 mmol/L were significant (P < 0.05) risk factors for LVDD. LAVI > 37 ml/m2, lateral e’ < 8 cm/s, E/lateral e’ > 13, and SOFA > 5 were significant (P < 0.05) independent risk factors for LVDD. ROC curve analysis demonstrated that the cut-off value and AUC were 37.09 mL/m2 and 0.85 for LAVI, 8.00 cm/s and 0.89 for lateral e’, 12.86 and 0.82 for E/lateral e’, and 5.00 and 0.69 for SOFA, respectively. Conclusion Left atrial volume index, mitral lateral e’, E/lateral e’, and SOFA score are significant independent risk factors for predicting left ventricular diastolic dysfunction in patients with septic shock.
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Affiliation(s)
- Wei-Dong Ge
- Department of Ultrasonography, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, 310000, Zhejiang, China
| | - Feng-Zhi Li
- Department of Ultrasonography, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, 310000, Zhejiang, China.,Department of Ultrasonography, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Bang-Chuan Hu
- Department of Ultrasonography, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, 310000, Zhejiang, China
| | - Li-Hong Wang
- Department of Ultrasonography, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, 310000, Zhejiang, China
| | - Ding-Yuan Ren
- Department of Ultrasonography, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, 310000, Zhejiang, China.
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Cylwik J, Buda N. The impact of ultrasound-guided recruitment maneuvers on the risk of postoperative pulmonary complications in patients undergoing general anesthesia. J Ultrason 2022; 22:e6-e11. [PMID: 35449694 PMCID: PMC9009342 DOI: 10.15557/jou.2022.0002] [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: 09/19/2021] [Accepted: 11/17/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Postoperative pulmonary complications are among the most frequent problems in perioperative care. The risk of their development depends not only on the parameters associated with the patient’s initial clinical condition, but also on the employed anesthesia technique, the method of mechanical ventilation, and the type and technique of the surgical procedure. Atelectasis is the most common complication, affecting nearly 90% of the patients undergoing general anesthesia. Aim The aim of this study was to determine whether it was possible to positively impact the postoperative period and reduce the frequency of postoperative pulmonary complications via patient-based intraoperative ultrasound-guided recruitment maneuvers. Methodology The course of the postoperative period was analyzed in two groups of patients. One of them comprised 100 patients in whom no recruitment maneuvers were performed during general anesthesia. The other group (100 patients) consisted of patients in whom patient-based ultrasound-guided pulmonary recruitment maneuvers were performed. Results In the recruitment group, the postoperative hospitalization was statistically significantly shorter (p = 0.003) and the risk of intensive care treatment significantly lower. Additionally, the need for prolonged postoperative mechanical ventilation was reduced, as was the risk of respiratory tract infections. Conclusions Intraoperative ultrasound-guided recruitment maneuvers reduce the frequency of postoperative pulmonary complications.
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Affiliation(s)
- Jolanta Cylwik
- Anesthesiology and Intensive Care Unit, Mazovia Regional Hospital in Siedlce, Poland
| | - Natalia Buda
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, Poland
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Stenberg Y, Rhodin Y, Lindberg A, Aroch R, Hultin M, Walldén J, Myrberg T. Pre-operative point-of-care assessment of left ventricular diastolic dysfunction, an observational study. BMC Anesthesiol 2022; 22:96. [PMID: 35382761 PMCID: PMC8981659 DOI: 10.1186/s12871-022-01642-4] [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: 12/17/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction is an acknowledged peri-operative risk factor that should be identified before surgery. This study aimed to evaluate a simplified echocardiographic method using e' and E/e' for identification and grading of diastolic dysfunction pre-operatively. METHODS Ninety six ambulatory surgical patients were consecutively included to this prospective observational study. Pre-operative transthoracic echocardiography was conducted prior to surgery, and diagnosis of LV diastolic dysfunction was established by comprehensive and simplified assessment, and the results were compared. The accuracy of e'-velocities in order to discriminate patients with diastolic dysfunction was established by calculating accuracy, efficiency, positive (PPV) and negative predictive (NPV) values, and area under the receiver operating characteristic curve (AUROC). RESULTS Comprehensive assessment established diastolic dysfunction in 77% (74/96) of patients. Of these, 22/74 was categorized as mild dysfunction, 43/74 as moderate dysfunction and 9/74 as severe dysfunction. Using the simplified method with e' and E/e', diastolic dysfunction was established in 70.8% (68/96) of patients. Of these, 8/68 was categorized as mild dysfunction, 36/68 as moderate dysfunction and 24/68 as severe dysfunction. To discriminate diastolic dysfunction of any grade, e'-velocities (mean < 9 cm s- 1) had an AUROC of 0.901 (95%CI 0.840-0.962), with a PPV of 55.2%, a NPV of 90.9% and a test efficiency of 0.78. CONCLUSIONS The results of this study indicate that a simplified approach with tissue Doppler e'-velocities may be used to rule out patients with diastolic dysfunction pre-operatively, but together with E/e' ratio the severity of diastolic dysfunction may be overestimated. TRIAL REGISTRATION Clinicaltrials.gov, Identifier: NCT03349593 . Date of registration 21/11/2017. https://clinicaltrials.gov .
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Affiliation(s)
- Ylva Stenberg
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, (Sunderbyn), Umeå University, Umeå, Sweden
| | - Ylva Rhodin
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, (Sunderbyn), Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Roman Aroch
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, (Umeå), Umeå University, Umeå, Sweden
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, (Umeå), Umeå University, Umeå, Sweden
| | - Jakob Walldén
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, (Sundsvall), Umeå University, Umeå, Sweden
| | - Tomi Myrberg
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, (Sunderbyn), Umeå University, Umeå, Sweden. .,Department of Anaesthesiology and Critical Care, Sunderby Hospital, 971 80, Luleå, Sweden.
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Cylwik J, Buda N. Lung Ultrasonography in the Monitoring of Intraoperative Recruitment Maneuvers. Diagnostics (Basel) 2021; 11:diagnostics11020276. [PMID: 33578960 PMCID: PMC7916700 DOI: 10.3390/diagnostics11020276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Postoperative respiratory failure is a serious problem in patients who undergo general anesthesia. Approximately 90% of mechanically ventilated patients during the surgery may develop atelectasis that leads to perioperative complications. Aim: The aim of this study is to determine whether it is possible to optimize recruitment maneuvers with the use of chest ultrasonography, thus limiting the risk of respiratory complications in patients who undergo general anesthesia. Methodology: The method of incremental increases in positive end-expiratory pressure (PEEP) values with simultaneous continuous ultrasound assessments was employed in mechanically ventilated patients. Results: The study group comprised 100 patients. The employed method allowed for atelectasis reduction in 91.9% of patients. The PEEP necessary to reverse areas of atelectasis averaged 17cmH2O, with an average peak pressure of 29cmH2O. The average PEEP that prevented repeat atelectasis was 9cmH2O. A significant improvement in lung compliance and saturation was obtained. Conclusions: Ultrasound-guided recruitment maneuvers facilitate the patient-based adjustment of the process. Consequently, the reduction in ventilation pressures necessary to aerate intraoperative atelectasis is possible, with the simultaneous reduction in the risk of procedure-related complications.
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Affiliation(s)
- Jolanta Cylwik
- Anesthesiology and Intensive Care Unit, Mazovia Regional Hospital, 08-110 Siedlce, Poland;
| | - Natalia Buda
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, 80-210 Gdańsk, Poland
- Correspondence:
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Zawadka M, Marchel M, Dudek P, Andruszkiewicz P, Jakimowicz T, Gąsecka A, Kutka M, Poelaert J. Cardiac Stress in High-Risk Patients Undergoing Major Endovascular Surgery-Focus on Diastolic Function. J Cardiothorac Vasc Anesth 2020; 35:2345-2354. [PMID: 33342737 DOI: 10.1053/j.jvca.2020.11.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the relationship between the changes in diastolic function and their association with cardiac biomarkers in the perioperative period in patients undergoing complex endovascular aortic repair. DESIGN Prospective observational study. SETTING Single-center academic hospital, central teaching hospital in Warsaw, Poland. PARTICIPANTS The study comprised 27 high-risk patients scheduled for elective endovascular repair of aortic aneurysm. INTERVENTIONS Complex endovascular procedure using branched endograft of the thoracoabdominal aorta. Branches of the stent grafts included renal arteries, the superior mesenteric artery, and the celiac trunk. MEASUREMENTS AND MAIN RESULTS The primary outcome was to evaluate changes in diastolic function parameters assessed with transthoracic echocardiography at two and 24 hours postoperatively. The major secondary outcomes were changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin I concentrations, systolic function parameters, hemodynamic parameters at two and 24 hours, length of hospital stay, and 30-day mortality. There was a reduction in e' wave velocity on both the septal and lateral sides at two hours compared with the baseline (p = 0.041 and p = 0.05, respectively). There was an increase in both NT-proBNP and troponin I concentrations after surgery (p = 0.002 and p = 0.034, respectively), with troponin I peaking two hours after surgery and NT-proBNP peaking 24 hours after surgery. CONCLUSIONS Patients undergoing a branched endovascular aortic repair of a thoracoabdominal aortic aneurysm experience a cardiac insult that manifests with deterioration in diastolic parameters and concomitant increases of troponin and NT-proBNP concentrations. Additional large-scale prospective studies are required to confirm this phenomenon.
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Affiliation(s)
- M Zawadka
- 2nd Department of Anesthesiology and Intensive Care Medical University of Warsaw, Warsaw, Poland; Perioperative Medicine, Barts Heart Centre and St. Bartholomew's Hospital, London, UK; Polish National Agency for Academic Exchange, Warsaw, Poland
| | - M Marchel
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
| | - P Dudek
- 2nd Department of Anesthesiology and Intensive Care Medical University of Warsaw, Warsaw, Poland
| | - P Andruszkiewicz
- Department of Anesthesiology and Intensive Care, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - T Jakimowicz
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - A Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - M Kutka
- 2nd Department of Anesthesiology and Intensive Care Medical University of Warsaw, Warsaw, Poland
| | - J Poelaert
- Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
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