Abstract
Objective: To estimate pre- and postoperative mechanical dispersion and deformation of myocardium, depending on the type of cardioplegia used, and to find out the diagnostic values in order to assess the risk of acute heart failure in the early postoperative period.
Material and methods. A prospective study of the results of treatment of 152 patients with congenital heart defects was done. Patients were divided into 2 groups depending on cardioplegia type. The analysis of myocardial deformation with quantitative assessment of regional left ventricular function with calculations of longitudinal, radial and circumferential strain to assess the effectiveness of myocardial protection was done.
Results. Statistically significant differences between the groups in the estimated parameters were revealed on the 3rd postoperative day. On the 7th day, the values of longitudinal and circular myocardial deformity did not differ significantly between the study groups. Radial deformation and mechanical dispersion had significant intergroup differences. To determine the diagnostic value of the parameters of the mechanical function of the heart for the risk of developing acute heart failure, an ROC analysis was performed. For longitudinal deformation of the myocardium, the result of calculating the area under the ROC curve (AUC) was 0.881 with a critical value of –17%, for radial deformation AUC – 0.863 with a critical value of 47.5%, for mechanical dispersion – 0.752 with a critical value of 23 ms. The lowest diagnostic value was found in the index of circular deformity – 0.646 with a critical point of –12.5%.
Conclusion. 1. Analysis of mechanical dispersion and left ventricular myocardium strain in patients after cardiac surgery in combination with hemodynamic and laboratory criteria for acute heart failure allows to compare the effectiveness of myocardial protection using different cardioplegic solutions. 2. The ROC analysis confirmed that mechanical dispersion and left ventricular myocardium strain can be used to evaluate the mechanical function of the myocardium and assess the effect of cardioplegia on the risk of developing acute heart failure in the early postoperative period.
References
- Khubulava G.G., Naumov A.B., Marchenko S.P., Chupaeva O.Yu., Seliverstova A.A., Aleksandrovich Yu.S. Indicators of blood gas composition in newborns with small cardiac output syndrome after cardiac surgery. The Bulletin of Bakoulev Center for Cardiovascular Diseases. 2018; 19 (5): 676–87 (in Russ.). DOI: 10.24022/1810-0694-2018-19-5-676-687
- Bockeria L.A., Movsesyan R.R., Musina R.A. Topical issues of intraoperative myocardial protection (cardioplegia). Russian Journal of Thoracic and Cardiovascular Surgery. 1998; 5: 63–70 (in Russ.).
- Smigla G., Jaquiss R., Walczak R., Bonadonna D., Kaemmer D., Schwimer C. et al. Assessing the safety of del Nido cardioplegia solution in adult congenital cases. Perfus (United Kingdom). 2014; 29 (6): 554–8. DOI: 10.1177/0267659114543346
- Gozdzik A., Letachowicz K., Grajek B.B., Plonek T., Obremska M., Jasinski M. et al. Application of strain and other echocardiographic parameters in the evaluation of early and long-term clinical outcomes after cardiac surgery revascularization. BMC Cardiovasc. Disord. 2019; 19 (1): 189. DOI: 10.1186/s12872-019-1162-8
- Friedberg M.K., Mertens L. Tissue velocities, strain, and strain rate for echocardiographic assessment of ventricular function in congenital heart disease. Eur. J. Echocardiogr. 2009; 10 (5): 585–93. DOI: 10.1093/ejechocard/jep045
- Averina T.B., Movsesyan R.R., Shebaev G.A. Modern strategies for myocardial protection in children. Children’s Heart and Vascular Diseases. 2007; 5: 45–53 (in Russ.).
- Kozar E.F., Plyushch M.G., Popov A.E., Kulaga O.I., Movsesyan R.R., Samsonova N.N. Markers of myocardial damage in children of the first year of life with congenital heart defects in the early period after operations with cardioplegic anoxia. The Bulletin of Bakoulev Center for Cardiovascular Diseases. 2014; 158 (10): 417–20 (in Russ.).
- Bockeria L.A., Averina T.B., Baranov V.V. Prokhorov A.V., Karaka N.N., Kuznetsov M.I. et al. Experience of using computerized capillaroscopy to diagnose the state of microcirculation during cardiac surgery with artificial circulation. The Bulletin of Bakoulev Center for Cardiovascular Diseases. 2008; 9 (1): 11–27 (in Russ.).
- Luis S.A., Chan J., Pellikka P.A. Echocardiographic assessment of left ventricular systolic function: an overview of contemporary techniques, including speckle-tracking echocardiography. Mayo Clin. Proc. 2019; 94 (1): 125–38. DOI: 10.1016/j.mayocp.2018.07.017
- Voigt J.-U., Exner B., Schmiedehausen K., Huchzermeyer C., Reulbach U., Nixdorff U. et al. Strain-rate imaging during dobutamine stress echocardiography provides objective evidence of inducible ischemia. Circulation. 2003; 107 (16): 2120–6. DOI: 10.1161/01.CIR.0000065249.69988.AA
- Sinel'nikov Yu.S., Orekhova E.N., Polevshchikova M.A. Longitudinal mechanics of the left ventricle in newborns with aortic coarctation before and after surgical correction. Clinical and Experimental Surgery. Petrovsky Journal. 2017; 5 (4 (18)): 43–50 (in Russ.).
- Sinel’nikov Yu.S., Orekhova E.N., Matanovskaya T.V. Longitudinal mechanics as predictors of left ventricular systolic function in the early postoperative period after surgical perimembranous ventricular septal defect closure in children aged <1 year. Circulation Pathology and Cardiac Surgery. 2019; 23 (1): 17–25 (in Russ.). DOI: 10.21688/1681-3472- 2019-1-17-25
- Khubulava G.G., Naumov A.B., Marchenko S.P., Tereshenko O.Yu., Kulemin E.S., Romanovskiy D.Yu., Biryukov A.V. Modified crystalloid-blood cardioplegia combined with low volume cardioplegic system in pediatric congenital cardiac surgery. Children’s Heart and Vascular Diseases. 2019; 16 (1): 5–15 (in Russ.). DOI: 10.24022/1810-0686-2019- 16-1-5-15
- Marchenko S.P., Khubulava G.G., Naumov A.B., Seliverstova A.A., Tsypurdeeva N.D., Suvorov V.V. et al. Pathophysiological principles and approaches to the assessment of hemodynamics. Pediatr (Pediatrician). 2014; 5 (4): 110–5 (in Russ.).
- Forsey J., Friedberg M.K., Mertens L. Speckle tracking echocardiography in pediatric and congenital heart disease. Echocardiography. 2013; 30 (4): 447–59. DOI: 10.1111/echo.12131
- Rychik J., Zeng S., Bebbington M., Szwast A., Quartermain M., Natarajan S. et al. Speckle tracking-derived myocardial tissue deformation imaging in twin-twin transfusion syndrome: differences in strain and strain rate between donor and recipient twins. Fetal Diagn. Ther. 2012; 32 (1–2): 131–7. DOI: 10.1159/000335403
- Brooks P.A., Khoo N.S., Mackie A.S., Hornberger L.K. Right ventricular function in fetal hypoplastic left heart syndrome. J. Am. Soc. Echocardiogr. 2012; 25 (10): 1068–74. DOI: 10.1016/j.echo.2012.06.005
- Menon S.C., Minich L.L., Casper T.C., Puchalski M.D., Hawkins J.A., Tani L.Y. et al. Regional myocardial dysfunction following Norwood with right ventricle to pulmonary artery conduit in patients with hypoplastic left heart syndrome. J. Am. Soc. Echocardiogr. 2011; 24 (8): 826–33. DOI: 10.1016/j.echo.2011.05.008
- Martsinkevich G.I., Sokolov A.A., Kovalev I.A., Murzina O.Yu., Popov S.V. Electromechanical coupling of myocardium in healthy persons and in pediatric patients with WPW-syndrome. Journal of Arrhythmology. 2004; 35: 38–44 (in Russ.).
- Fernandes F.P., Manlhiot C., Roche S.L., Grosse-Wortmann L., Slorach C., McCrindle B.W. et al. Impaired left ventricular myocardial mechanics and their relation to pulmonary regurgitation, right ventricular enlargement and exercise capacity in asymptomatic children after repair of tetralogy of Fallot. J. Am. Soc. Echocardiogr. 2012; 25 (5): 494–503. DOI: 10.1016/j.echo.2012.01.014
- Kutty S., Deatsman S.L., Russell D., Nugent M.L., Simpson P.M., Frommelt P.C. Pulmonary valve replacement improves but does not normalize right ventricular mechanics in repaired congenital heart disease: a comparative assessment using velocity vector imaging. J. Am. Soc. Echocardiogr. 2008; 21 (11): 1216–21. DOI: 10.1016/j.echo.2008.08.009
- Marcus K.A., de Korte C.L., Feuth T., Thijssen J.M., van Oort A.M., Tanke R.B. et al. Persistent reduction in left ventricular strain using two-dimensional speckle-tracking echocardiography after balloon valvuloplasty in children with congenital valvular aortic stenosis. J. Am. Soc. Echocardiogr. 2012; 25 (5): 473–85. DOI: 10.1016/j.echo.2012.01.009
- Martsinkevich G.I., Krivoshchekov E.V., Sokolov A.A. Postoperative heart remodeling in children for the correction of interventricular defects. Siberian Medical Journal (Irkutsk). 2012; 27 (1): 44–8 (in Russ.).
- Sokolov A.A., Martsinkevich G.I. Heart Failure in patients with preserved ejection fraction – pumping heart failure? Kardiologiia. 2018; 58 (6): 79–84. (in Russ.). DOI: 10.18087/cardio.2018.6.10125
- Shibeko N.A., Gelis L.G., Rusak T.V., Semenova N.V., Kovsh E.V. The effect of cardiac factors on the development of perioperative acute heart failure in coronary bypass surgery in patients with ischemic heart disease and mid-range ejection fraction. Cardiology in Belarus. 2017; 5 (5): 945–53 (in Russ.).
- Sokolov A.A., Martsinkevich G.I., Krivoshchekov E.V. Ultrasound assessment of the function of a single ventricle at the stages of defect correction, problem and solution. Cardiology in Belarus. 2011; 5 (18): 397–8 (in Russ.).
- Perdreau E., Séguéla P.E., Jalal Z., Perdreau A., Mouton J.-B., Nelson-Veniard M. et al. Évaluation de la fonction ventriculaire gauche postopératoire par 2D strain (speckle tracking) aprés chirurgie cardiaque pédiatrique. Arch. Cardiovasc. Dis. 2016; 109 (11): 599–606. DOI: 10.1016/j.acvd.2016.03.005
- Akhmedov Sh.D., Krivoshchekov E.V., Pekarskaya M.V., Krylov A.L., Vesnina Zh.V., Taranov S.V. Long-term clinical results of cardiomyoplasty. Kardiologiia. 1996; 36 (6): 74–7 (in Russ.).
- Shipulin V.M., Kazakov V.A., Krivoshchekov E.V., Sukhodolo I.V., Vaizov V.Kh., Lezhnev A.A. et al. Morphological predictors of postoperative cardiac remodeling in patients with ischemic cardiomyopathy. Kardiologiia. 2007; 47 (8): 57–9 (in Russ.).
- Orde S., Huang S.J., McLean A.S. Speckle tracking echocardiography in the critically ill: Enticing research with minimal clinical practicality or the answer to non-invasive cardiac assessment? Anaesth. Intensive Care. 2016; 44 (5): 542–51. DOI: 10.1177/0310057x1604400518
- Koopman L.P., Slorach C., Hui W., Manlhiot C., McCrindle B.W., Friedberg M.K. et al. Comparison between different speckle tracking and color tissue Doppler techniques to measure global and regional myocardial deformation in children. J. Am. Soc. Echocardiogr. 2010; 23 (9): 919–28. DOI: 10.1016/j.echo.2010.06.014
About the authors
- Aleksey B. Naumov, Cand. Med. Sc., Associate Professor, ORCID
- Gennadiy G. Khubulava, Dr. Med. Sc., Professor, Academician of RAS, Chief of Chair, Chief Cardiac Surgeon of the Northwestern Federal District of the Russian Federation, ORCID
- Sergey P. Marchenko, Dr. Med. Sc., Professor, Head of Department, ORCID
- Evgeniy S. Kulemin, Cardiac Surgeon, Head of Department, ORCID
- Paul R. Vogt, Professor, Cardiovascular Surgeon, Chief Cardiac Surgeon at the Center for Cardiovascular Surgery at the Im Park Clinic (Zurich, Switzerland); Professor of Faculty Surgery Pavlov First Saint Petersburg State Medical University
- Dmitriy D. Kupatadze, Dr. Med. Sc., Professor, Chief of Chair, ORCID
- Ol’ga Yu. Tereshenko, Anesthesiologist-Intensivist, ORCID
- Nikolay G. Pilyugov, Anesthesiologist-Intensivist, ORCID
- Anastasiya A. Seliverstova, Pediatric Cardiologist, ORCID
- Aleksandra V. Chernomordova, Assistant Professor, ORCID
- Mikhail S. Andreev, Researcher, ORCID
- Tat’yana A. Maryutina, Anesthesiologist-Intensivist, ORCID
- Oksana V. Nevmerzhitskaya, Cand. Med. Sc., Head of Department, ORCID
- Ol’ga Yu. Chupaeva, Researcher, ORCID
- Irina N. Azarova, Cardiologist, Researcher
- Pavel S. Kal’noy, Assistant Professor, ORCID
- Andrey B. Sazonov, Dr. Med. Sc., Professor, ORCID
- Andrey M. Volkov, Associate Professor, ORCID
