Left Ventricular Systolic Impairment after Pediatric Cardiac Surgery Assessed by STE Analysis
Abstract
:1. Introduction
2. Methods
2.1. Ethics
2.2. Surgical and Medical Management
2.3. Statistical Analysis
3. Results
3.1. Population
3.2. Feasibility
3.3. Preoperative LV Strain Values
3.4. Progression of Global LV Strain Values as a Function of Postoperative Time
3.5. Progression of Segmental LV Strain Values as a Function of Postoperative Time
3.6. Differences of LV Ventricular Strain Values among Age Groups
3.7. Strain and Left Ventricular Ejection Fraction
3.8. Inotrope Data and Vasoactive–Inotropic Score
3.9. Correlation of Ventricular Strain with Conventional Risk Factors and Operative Data
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A
Postoperative Times | STE | Neonates | Infant | Older | Older vs. Infant | Older vs. Neonates | Neonates vs. Infant | |||
---|---|---|---|---|---|---|---|---|---|---|
Variables | STE | Mean | Dev std | Mean | Dev std | Mean | Dev std | p | p | p |
Time 1 | LV 4 Ch ε | 22.37 | 4.03 | 20.74 | 5.53 | 20.14 | 4.84 | 0.6 | 0.048 * | 0.21 |
LV 2 Ch ε | 22.54 | 3.85 | 21.93 | 6.63 | 19.91 | 4.72 | 0.09 | 0.03 * | 0.66 | |
LV 3 Ch ε | 21.62 | 3.82 | 20.61 | 5.35 | 19.28 | 4.81 | 0.23 | 0.04 * | 0.44 | |
LVGL ε | 22.11 | 3.36 | 20.15 | 5.92 | 19.71 | 4.4 | 0.7 | 0.03 * | 0.12 | |
Time 2 | LV 4 Ch ε | 24.54 | 3.44 | 21.39 | 4.53 | 20.58 | 4.41 | 0.5 | 0.0004 * | 0.013 * |
LV 2 Ch ε | 24.96 | 3.79 | 21.84 | 3.43 | 20.84 | 4.59 | 0.3 | 0.0002 * | 0.013 * | |
LV 3 Ch ε | 23.02 | 3.6 | 21 | 4.59 | 19.87 | 4.43 | 0.31 | 0.0048 * | 0.11 | |
LVGL ε | 24.22 | 3.25 | 21.3 | 3.68 | 20.38 | 4.21 | 0.36 | 0.0002 * | 0.013 * | |
Time 3 | LV 4 Ch ε | 25.47 | 3.96 | 22.56 | 3.84 | 22.73 | 4.88 | 0.89 | 0.04 * | 0.05 |
LV 2 Ch ε | 24.65 | 4.3 | 22.78 | 3.78 | 21.8 | 4.42 | 0.43 | 0.03 * | 0.2 | |
LV 3 Ch ε | 23.95 | 3.34 | 22.9 | 3.71 | 21.69 | 4.18 | 0.3 | 0.06 | 0.42 | |
LVGL ε | 24.66 | 3.29 | 22.68 | 3.42 | 22.02 | 3.9 | 0.54 | 0.02 * | 0.11 |
STE | Age | BSA | Aristotle Score | STAT | CPB | Cross Clamp | LVEF | |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Variables | beta | p | beta | p | p | p | beta | p | beta | p | beta | p |
LV 4 Ch ε | −0.4 | 0.0012 * | −4.8 | 0.0002 * | 0.6 | 0.8 | −0.01 | 0.04 * | 0.2 | 1.34 | <0.0001 | |
LV 2 Ch ε | −0.5 | <0.0001 * | −5.51 | <0.0001 * | 0.7 | 0.9 | 0.08 | 0.2 | 1.29 | <0.0001 | ||
LV 3 Ch ε | −0.5 | <0.0001 * | −5.47 | <0.0001 * | 0.7 | 0.7 | −0.02 | 0.006 * | 0.05 | 1.49 | <0.0001 | |
LVGL ε | −0.5 | 0.0002 * | −4.91 | <0.0001 | 0.9 | 0.9 | −0.02 | 0.0006 * | −0.03 | 0.007 * | 1.51 | <0.0001 |
Mean Basal Segments | −0.3 | 0.0015 * | −3.77 | 0.0013 * | 0.5 | 0.7 | 0.13 | 0.4 | 1.04 | <0.0001 | ||
Mean Mid Segments | −0.2 | 0.05 | −2.31 | 0.06 | 0.8 | 0.05 | −0.02 | 0.03 * | 0.1 | 0.9 | <0.0001 | |
Mean Apical Segments | −0.6 | <0.0001 * | −6.94 | <0.0001 * | 0.2 | 0.9 | 0.1 | 0.3 | 0.93 | <0.0001 |
VISmax Category | Neonates | Infant | Older | All | ||||
---|---|---|---|---|---|---|---|---|
% | N | % | N | % | N | % | N | |
0−5 | 42.31% | 11 | 61.29% | 19 | 73.33% | 44 | 63.25% | 74 |
5−15 | 46.15% | 12 | 38.71% | 12 | 25% | 15 | 33.30% | 39 |
15−30 | 11.54% | 3 | 0.0% | 0 | 1.67% | 1 | 3.42% | 4 |
30−45 | 0.0% | 0 | 0.0% | 0 | 0.0% | 0 | 0.0% | 0 |
>45 | 0.0% | 0 | 0.0% | 0 | 0.0% | 0 | 0.0% | 0 |
No Vasoactive–Inotropes Administration | 11.50% | 3 | 12.90% | 4 | 45% | 27 | 29.10% | 34 |
STE | Inotropes-Group | No Inotropes-Group | Inotropes-Group | No Inotropes-Group | Comparison Inotropes vs. No Inotropes | |||||
---|---|---|---|---|---|---|---|---|---|---|
STE | Time 1 | Time 2 | Time 1 | Time 2 | ||||||
Variables | Mean | Dev std | Mean | Dev std | Mean | Dev std | Mean | Dev std | p | p |
LV 4 Ch ε | 21.15 | 4.83 | 19.91 | 5.08 | 22.25 | 4.47 | 21.25 | 4.5 | 0.23 | 0.29 |
LV 2 Ch ε | 21.6 | 5.06 | 19.58 | 5.31 | 22.57 | 4.15 | 21.63 | 4.72 | 0.07 | 0.31 |
LV 3 Ch ε | 20.69 | 4.46 | 18.82 | 5.43 | 21.13 | 4.27 | 20.72 | 4.62 | 0.07 | 0.66 |
LVGL ε | 21 | 4.07 | 18.84 | 5.81 | 21.95 | 3.99 | 21.15 | 4.29 | 0.03 * | 0.35 |
Mean Basal Segments | 17.75 | 3.94 | 16.53 | 5.16 | 18.07 | 3.46 | 18.22 | 4.29 | 0.17 | 0.85 |
Mean Mid Segments | 17.93 | 4.1 | 18.17 | 5.64 | 18.84 | 4.11 | 18.91 | 4.73 | 0.8 | 0.9 |
Mean Apical Segments | 23.3 | 5.14 | 21.67 | 7.16 | 24.74 | 5.04 | 23.48 | 5.59 | 0.17 | 0.26 |
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Characteristic | Neonates | Infant | Older | |||
---|---|---|---|---|---|---|
Variables | Mean (Median) | Dev std (IQR) | Mean (Median) | Dev std (IQR) | Mean (Median) | Dev std (IQR) |
Age (years) | 0.027 (0.02) | 0.01 (0.02–0.03) | 0.25 (0.25) | 0.13 (0.12–0.38) | 4.37 (1.92) | 4.63 (0.95–6.8) |
Age (months) | 0.33 (0.3) | 0.19 (0.22–0.38) | 3.12 (3.07) | 1.57 (1.5–4.63) | 53.16 (23.33) | 56.29 (11.5–82.76) |
Age (days) | 9.88 (9) | 5.58 (6.5–11.5) | 93.74 (92) | 46.95 (45–139) | 1594.89 (700) | 1688.57 (345–248.75) |
Weight (Kg) | 3.25 (3.29) | 0.62 (2.98–3.57) | 5.03 (4.92) | 1.64 (3.95–5.93) | 17.27 (11.03) | 14.18 (6.75–24) |
Height (cm) | 49.92 (51) | 5.26 (48.5–52.5) | 60.47 (59) | 10.50 (53.5–64.25) | 95.12 (83) | 34.61 (67–124) |
BSA (m2) | 0.21 (0.21) | 0.03 (0.21–0.23) | 0.29 (0.29) | 0.06 (0.25–0.35) | 0.66 (0.5) | 0.38 (0.36–0.9) |
CPB (min) | 142.74 (177) | 103.13 (0–219) | 102.48 (93) | 63.68 (63–134) | 101.74 (99.5) | 47.51 (69.5–120) |
Cross Clamp (min) | 93.38 (99.5) | 70.62 (27–128.75) | 62.00 (62) | 43.11 (36.5–87) | 65.36 (61.5) | 35.94 (40–85) |
Aristotle score | 8.77 (10) | 1.95 (6–10) | 6.89 (6.3) | 1.37 (6–8) | 6.38 (6.3) | 2.33 (6–8) |
STAT | 2.11 (3) | 0.99 (1–3) | 1.46 (1) | 0.81 (1–2) | 1.45 (1) | 0.67 (1–2) |
Classification | Neonates | Infant | Older | |||
LVVO | 1.00 | 16.00 | 16.00 | |||
RVPO | 0.00 | 5.00 | 16.00 | |||
LVPO | 8.00 | 2.00 | 10.00 | |||
TGA | 16.00 | 3.00 | 0.00 | |||
RVVO | 0.00 | 1.00 | 14.00 | |||
AVSD | 1.00 | 2.00 | 4.00 | |||
Other | 0.00 | 2.00 | 0.00 |
STE | Neonates (%) | Infants (%) | Older (%) | Total (%) |
---|---|---|---|---|
LV 4 Ch ε | 98.5 | 97.4 | 96.2 | 97.1 |
LV 2 Ch ε | 96.5 | 94.8 | 96.2 | 96.3 |
LV 3 Ch ε | 97.5 | 94.8 | 96.2 | 96.3 |
LVGL ε | 98.5 | 97.4 | 97.7 | 97.8 |
STE | Before Surgery (Pre) | Time 1 | Time 2 | Time 3 | Healthy Subjects | |||||
---|---|---|---|---|---|---|---|---|---|---|
Variables | Mean | Dev std | Mean | Dev std | Mean | Dev std | Mean | Dev std | Mean | Dev std |
LV 4 Ch ε | 24.98 | 4.22 | 20.81 | 4.91 | 21.76 | 4.49 | 23.4 | 4.49 | 24.93 | 2.77 |
LV 2 Ch ε | 25.24 | 4.24 | 21.04 | 5.19 | 22.11 | 4.44 | 22.82 | 4.32 | 25.19 | 2.74 |
LV 3 Ch ε | 25.46 | 4.24 | 20.17 | 4.8 | 20.93 | 4.43 | 22.61 | 3.91 | 23.8 | 3.48 |
LVGL ε | 25.23 | 4.23 | 20.37 | 4.71 | 21.56 | 4.14 | 22.9 | 3.73 | 24.84 | 2.67 |
Mean Basal Segments | 28.64 | 4.9 | 17.39 | 4.34 | 18.15 | 3.87 | 20.2 | 3.97 | 23.03 | 2.77 |
Mean Mid Segments | 23.19 | 5.05 | 18 | 4.57 | 18.88 | 4.4 | 20.81 | 3.85 | 24.11 | 2.85 |
Mean Apical Segments | 21.94 | 4.83 | 22.83 | 5.82 | 24.12 | 5.33 | 26.63 | 5.38 | 29.05 | 3.25 |
STE | Pre vs. T1 | Pre vs. T2 | Pre vs. T3 | Pre vs. Controls | Control vs. Time 1 | Control vs. Time 2 | Control vs. Time 3 | Time 1 vs. Time 2 | Time 2 vs. Time 3 | Time 1 vs. Time 3 |
---|---|---|---|---|---|---|---|---|---|---|
Variables | p | p | P | p | p | p | p | p | p | p |
LV 4 Ch ε | <0.0001 * | <0.0001 * | 0.048 * | 0.9 | 0.0009 * | 0.0077 * | 0.005 * | 0.6 | 0.5 | 0.23 |
LV 2 Ch ε | <0.0001 * | <0.0001 * | 0.003 * | 0.9 | <0.0001 * | <0.0001 * | 0.0004 * | 0.07 | 0.3 | 0.007 * |
LV 3 Ch ε | <0.0001 * | <0.0001 * | 0.0002 * | 0.0084 * | <0.0001 * | <0.0001 * | 0.07 | 0.2 | 0.01 * | 0.0002 * |
LVGL ε | <0.0001 * | <0.0001 * | 0.002 * | 0.47 | <0.0001 * | <0.0001 * | 0.002 * | 0.03 * | 0.03 * | <0.0001 * |
Mean Basal Segments | <0.0001 * | <0.0001 * | <0.0001 * | <0.0001 * | <0.0001 * | <0.0001 * | <0.0001 * | 0.19 | 0.0013 * | <0.0001 * |
Mean Mid Segments | <0.0001 * | <0.0001 * | 0.0042 * | 0.14 | <0.0001 * | <0.0001 * | <0.0001 * | 0.16 | 0.005 * | <0.0001 * |
Mean Apical Segments | 0.33 | 0.0149 * | <0.0001 * | <0.0001 * | <0.0001 * | <0.0001 * | 0.0003 * | 0.09 | 0.004 * | <0.0001 * |
Percentile | <5th | 5–10th | 10–25th | 25–50th | 50–75th | 75–90th | 90–95th | >95th |
---|---|---|---|---|---|---|---|---|
Preoperative | 14.8% | 5.6% | 7.4% | 22.2% | 16.7% | 13.0% | 5.6% | 14.7% |
Time 1 | 61.40% | 5.26% | 14.04% | 9.65% | 3.51% | 5.26% | 0.00% | 0.88% |
Time 2 | 53.26% | 2.17% | 17.39% | 15.22% | 6.52% | 4.35% | 1.09% | 0.00% |
Time 3 | 43.75% | 4.69% | 14.06% | 18.75% | 6.25% | 7.81% | 0.00% | 4.69% |
Age Group | Time of Examination | Ejection Fraction (%) | |||||
---|---|---|---|---|---|---|---|
Normal (>50%) | Mildly Decreased (40–50%) | Reduced (<40%) | |||||
Newborn | Before Surgery | 100.00% | 0.00% | 0.00% | |||
Time 1 | 92.31% | 7.69% | 0.00% | ||||
Time 2 | 100.00% | 0.00% | 0.00% | ||||
Time 3 | 100.00% | 0.00% | 0.00% | ||||
Infant | Before Surgery | 100.00% | 0.00% | 0.00% | |||
Time 1 | 78.57% | 14.29% | 7.14% | ||||
Time 2 | 85.71% | 4.76% | 9.52% | ||||
Time 3 | 100.00% | 0.00% | 0.00% | ||||
Older | Before Surgery | 100.00% | 0.00% | 0.00% | |||
Time 1 | 81.36% | 13.56% | 5.08% | ||||
Time 2 | 82.61% | 10.87% | 6.52% | ||||
Time 3 | 93.10% | 6.90% | 0.00% | ||||
All | Before Surgery | 100.00% | 0.00% | 0.00% | |||
Time 1 | 83.2% | 12.39% | 4.42% | ||||
Time 2 | 87.78% | 6.67% | 5.56% | ||||
Time 3 | 96.83% | 3.17% | 0.00% | ||||
Ejection Fraction over time | |||||||
Ejection Fraction (%) | Mean ± dev std | 63.7 ± 5.1 | 58.6 ± 9.7 | 61.6 ± 10.7 | 63.8 ± 7.9 | ||
Ejection Fraction | Before Surgery to Time 1 | Before Surgery to Time 2 | Before Surgery to Time 3 | Time 1 to Time 2 | Time 2 to Time 3 | Time 1 to Time 3 | |
Ejection Fraction (%) | p | 0.0004 * | 0.17 | 0.9 | 0.041 * | 0.17 | 0.0004 * |
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Cantinotti, M.; Marchese, P.; Scalese, M.; Medino, P.; Jani, V.; Franchi, E.; Vitali, P.; Santoro, G.; Viacava, C.; Assanta, N.; et al. Left Ventricular Systolic Impairment after Pediatric Cardiac Surgery Assessed by STE Analysis. Healthcare 2021, 9, 1338. https://doi.org/10.3390/healthcare9101338
Cantinotti M, Marchese P, Scalese M, Medino P, Jani V, Franchi E, Vitali P, Santoro G, Viacava C, Assanta N, et al. Left Ventricular Systolic Impairment after Pediatric Cardiac Surgery Assessed by STE Analysis. Healthcare. 2021; 9(10):1338. https://doi.org/10.3390/healthcare9101338
Chicago/Turabian StyleCantinotti, Massimiliano, Pietro Marchese, Marco Scalese, Paola Medino, Vivek Jani, Eliana Franchi, Pak Vitali, Giuseppe Santoro, Cecilia Viacava, Nadia Assanta, and et al. 2021. "Left Ventricular Systolic Impairment after Pediatric Cardiac Surgery Assessed by STE Analysis" Healthcare 9, no. 10: 1338. https://doi.org/10.3390/healthcare9101338