Feasibility of speckle-tracking echocardiography for assessment of left ventricular dysfunction after cardiopulmonary bypass.
OBJECTIVE
Effects of temporary biventricular pacing after cardiopulmonary bypass are unpredictable, and the utility of speckle-tracking echocardiography in this setting is unclear. Accordingly, speckle-tracking analysis of transgastric echocardiograms taken during cardiac surgery was assessed as a potential tool to measure strain, synchrony, and twist as indices to predict response.


METHODS
Prospective observational study, in part, with a randomized controlled study of temporary permanent biventricular pacing after cardiopulmonary bypass.


METHODS
Single-center study at university-affiliated tertiary care hospital.


METHODS
Twenty-one cardiac surgery candidates with ejection fraction ≤40% and QRS duration ≥100 ms or who were undergoing double-valve surgery.


METHODS
Transgastric views of the basal, midpapillary, and apical levels of the left ventricle were acquired before and after bypass.


RESULTS
Midpapillary sections were analyzable in 38% of patients. The remainder had epicardial borders extending beyond the field of view (24%) or inadequate image quality (38%). Only 9% of basal or apical sections were analyzable. Midpapillary radial strain and synchrony changed insignificantly after bypass. Variation in fractional area change correlated with changes in radial strain (p = 0.041) but not with synchrony.


CONCLUSIONS
Intraoperative transgastric echocardiography is inadequate for speckle-tracking analysis with current techniques. Intraoperative predictors of temporary biventricular pacing response are lacking.
Department of Surgery, Columbia Presbyterian Medical Center, New York, NY; Duke University School of Medicine, Durham, NC.
Alice
A
Wang
Department of Surgery, Columbia Presbyterian Medical Center, New York, NY.
Santos E
SE
Cabreriza
Department of Biostatistics, Mailman School of Public Health of Columbia University, New York, NY.
Bin
B
Cheng
Division of Cardiothoracic Anesthesiology, Columbia Presbyterian Medical Center, New York, NY.
Jack S
JS
Shanewise
Department of Surgery, Columbia Presbyterian Medical Center, New York, NY. Electronic address: hms2@columbia.edu.
Henry M
HM
Spotnitz
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D004452:Echocardiography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology
perioperative biventricular pacing; rotation; speckle-tracking echocardiography; strain; synchrony; transgastric echocardiography; twist