Cardiothoracic & vascular anesthesia
Intraoperative Noninvasive Left Ventricular Myocardial Work Indices in Patients Undergoing On-Pump Coronary Artery Bypass Surgery
Authors' conclusion
The intraoperative analysis of noninvasive echocardiographically-assessed LV MW indices is feasible. In the short-term period after uncomplicated on-pump CABG, GLS, as well as global and constructive MW, decreased, whereas wasted work increased, resulting in a less efficient left ventricle. None of these aspects was detected by conventional echocardiographic parameters.
Study context
- Population
- Patients with preserved left ventricular (LV) and RV function, sinus rhythm, no significant valve disease or pulmonary hypertension, uncomplicated intraoperative course, scheduled for isolated on-pump coronary artery bypass graft (CABG)
- Participants
- 25 patients
- Exposure
- Intraoperative transesophageal echocardiography (TEE) LV myocardial work indices vs conventional 2D/3D echo parameters, after induction (T1), after CPB (T2), after sternal closure (T3)
- Outcome
- Feasibility and intraoperative course of LV myocardial work indices (GWI, GCW, GWW, GWE) vs 2D/3D EF and GLS
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
LV myocardial work indices and GLS, T1 vs T2
| Group | Value | Global longitudinal strain (GLS) | Global constructive work (GCW) | Global wasted work (GWW) (median) | Global work efficiency (GWE) (median) |
|---|---|---|---|---|---|
| T1 | mean 1,224 (SD 312) mmHg% | −13.3 ± 3.0% | 1,460 ± 312 mmHg% | 143 mmHg% (IQR 99-183) | 89% (IQR 85-92) |
| T2 | mean 940 (SD 267) mmHg% | −11.6 ± 3.1% | 1,244 ± 336 mmHg% | 251 mmHg% (IQR 179-361) | 80% (IQR 75-87) |
Value
T1mean 1,224 (SD 312) mmHg%
T2mean 940 (SD 267) mmHg%
Global longitudinal strain (GLS)
T1−13.3 ± 3.0%
T2−11.6 ± 3.1%
Global constructive work (GCW)
T11,460 ± 312 mmHg%
T21,244 ± 336 mmHg%
Global wasted work (GWW) (median)
T1143 mmHg% (IQR 99-183)
T2251 mmHg% (IQR 179-361)
Global work efficiency (GWE) (median)
T189% (IQR 85-92)
T280% (IQR 75-87)
- T2 vs T1: P < 0.001 — declined significantly
- T2 vs T1: P = 0.012 — deteriorated significantly
- T2 vs T1: P = 0.005 — declined
- T2 vs T1: P < 0.001 — increased
- T2 vs T1: P < 0.001 — decreased
Observational data: associations, not effects.
Further findings
2D and 3D ejection fraction (EF), GLS, global work index (GWI), GCW, GWW, GWE before vs after sternal closure (T2 vs T3)
- No significant changes
Original publication
Intraoperative Noninvasive Left Ventricular Myocardial Work Indices in Patients Undergoing On-Pump Coronary Artery Bypass Surgery. J Cardiothorac Vasc Anesth. Published 29 October 2022. doi:10.
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