收缩期纵向应变评估冠状动脉搭桥围术期左心室收缩功能变化

Systolic longitudinal strain for assessing left ventricular systolic function changes during perioperative period of coronary artery bypass graft

目的观察冠状动脉搭桥(CABG)患者围术期左心室纵向收缩功能变化。方法前瞻性纳入41例确诊冠心病(CAD)并接受CABG患者,监测术前及术后当日、第3日及第7日左心室收缩期整体纵向应变(GLS)。根据术前左心室GLS分为3组:正常组(A组,GLS≤-18.1%)6例、轻度下降组(B组,-18.1%<GLS≤-14.0%)22例、重度下降组(C组,GLS>-14.0%)13例。以重复测量方差分析、广义估计方程及多重比较分析各时间点左心室收缩功能的差异。结果A、C组围术期各时间点GLS差异无统计学意义(校正P均>0.05);B组术后各时间点GLS均低于术前,术后当日最低(校正P均<0.001),而术后第3日与第7日GLS差异无统计学意义(校正P=1.00)。术后当日及第3日左心室基底段,术后各时间点左心室中间段和心尖段纵向应变(LS)均较术前下降(校正P均<0.05),尤以术后当日心尖段下降幅度最大;左心室各节段术后第3与第7日LS差异均无统计学意义(校正P均>0.05)。结论CABG术前GLS轻度下降的CAD患者术后当日左心室GLS明显下降并于术后1周内部分恢复;左心室各心肌节段中,CABG对心尖段LS的影响最为显著。

Objective To explore left ventricular longitudinal systolic function changes during perioperative period of coronary artery bypass graft(CABG).Methods Totally 41 patients with confirmed coronary artery disease(CAD)who underwent CABG were prospectively enrolled.The preoperative left ventricular global longitudinal strain(GLS),as well as GLS on the day of CABG,on the 3rd and 7th day postoperation were measured.According to preoperative left ventricular GLS,the patients were divided into 3 groups,i.e.normal group(group A,GLS≤-18.1%,n=6),mildly decreased group(group B,-18.1%<GLS≤-14.0%,n=22)and severely decreased group(group C,GLS>-14.0%,n=13).Repeated measures analysis of variance,generalized estimating equation and multiple comparisons were used to analyze left ventricular systolic function in different perioperative time points.Results No significant difference of GLS was found among different time points during perioperative period of CABG in group A and C(all adjusted P>0.05).In group B,GLS on postoperative days were lower than that before CABG(all adjusted P<0.001),and the lowest value was observed on the day of CABG postoperatively,while no significant difference of GLS was found between the 3rd and 7th day postoperation(adjusted P=1.00).Compared with those before CABG,the longitudinal strain(LS)of basal segment on the day of CABG postoperatively and 3rd day postoperation,of middle segment and apical segment at all postoperative time points were lower(all adjusted P<0.05),while of the apical segment on the day of CABG postoperatively decreased most obviously.No significant difference of LS of each ventricular segment was found between the 3rd nor the 7th day postoperation(all adjusted P>0.05).Conclusion GLS decreased significantly on the day of CABG postoperatively but partially recovered within the following week in CAD patients with mildly decreased preoperative GLS.CABG had the most pronounced effect on LS of apical segment in left ventricle.