Cardiac Functional Disturbances During Surgery
Conditions
Brief summary
This study aims to examine the correlation and agreement of regional and global measurements of ventricular function in the apical 4 chamber and subcostal 4 chamber view. Additionally, we will explore limitations of the technology and explore the effect of left lateral positioning.
Detailed description
In transthoracic echocardiography, a number of measures are endorsed by current guidelines for quantifying ventricular function. These include conventional (mitral annular plane velocities, ejection fraction) and novel, speckle-tracking (STE) technologies. However, these measurements are standardized to be measured in the left lateral decubitus position in the apical (4-chamber) view of awake spontaneously breathing patients. In the perioperative period, however, attaining these measurements in the endorsed circumstances may be challenging for a number of reasons. First, obtaining usable AP4C images may be difficult in ventilated or post-surgical patients. While the SC4C is generally obtainable visualized structures are not identical to those of the AP4C and measurement technologies such as Doppler are misaligned Secondly, patient conditions (e.g. in distress, or during surgery) may preclude positioning the patient in the left lateral decubitus position. Finally, patients may be ventilated and under anesthesia. Newer technologies - such as speckle-tracking- may partially overcome these difficulties as these technologies are considered to be relatively angle independent. For quantification, it would be important to know whether or not speckle-tracking based measurements in the SC4C are sufficiently close to those measured under the endorsed conditions.
Interventions
None listed
Sponsors
Eckhard Mauermann
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Consenting adult patients undergoing elective non-cardiac surgery
Exclusion criteria
* Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, dementia, etc. of the participant, * Previous enrolment into the current study, * Emergency procedures mandating expeditive patient care, * Nonregular heart rhythm * Valvular heart disease in the LV at least midgrade
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| S'Tissue Doppler Index (TDI) AP4C supine vs. S'STE SC4C supine | This is going to be assessed after the trans thoracic echocardiography, through study completion (an average of 1 year) | \- Comparison of two velocities measured by two different methods. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Global longitudinal strain (GLS), AP4C supine vs. GLS, SC4C supine, i.e. clinical questions: can we use the SC4C for global markers of ventricular function? | This is going to be assessed after the trans thoracic echocardiography, through study completion (an average of 1 year) | * Correlation: GLS, AP4C, supine vs. GLS, SC4C supine * Bland Altman (BA) Plot: GLS, AP4C, supine vs. GLS, SC4C supine |
Other
| Measure | Time frame | Description |
|---|---|---|
| Comparison of high Frame Rate (FR) vs. low FR of the following measures: [ i) S'STE AP4C supine, ii) GLS AP4C supine, iii) SR AP4C supine] | This is going to be assessed after the trans thoracic echocardiography, through study completion (an average of 1 year) | With high Frame Rate (FR) the measures will be more exact than with low FR |
| Comparison of the measured values in the cardiological gold standard (Left lateral decubitus (LLD)) vs. supine, for the following values [ i) S'TDI AP4C, ii) S'STE AP4C, iii) GLS] | This is going to be assessed after the trans thoracic echocardiography, through study completion (an average of 1 year) | Comparison of values in different patient position for TTE |
Countries
Switzerland
Contacts
Primary ContactMichael Lampart, Prakt. med.
Backup ContactEckhard Mauermann, PD
Outcome results
None listed