Does Adult Spinal Deformity Affect Cardiac Function? A Prospective Perioperative Study

医学 围手术期 射血分数 后凸 心脏病学 前瞻性队列研究 前凸 逻辑回归 内科学 外科 射线照相术 心力衰竭
作者
Yuki Mihara,Takeji Saitoh,Tomohiko Hasegawa,Yu Yamato,Go Yoshida,Tomohiro Banno,Hideyuki Arima,Shin Oe,Koichiro Ide,Tomohiro Yamada,Kenta Kurosu,Keiichi Nakai,Yukihiro Matsuyama
出处
期刊:Spine [Lippincott Williams & Wilkins]
卷期号:48 (12): 832-842
标识
DOI:10.1097/brs.0000000000004622
摘要

Prospective comparative study.The objective of this study was to investigate perioperative cardiac function using echocardiography in patients undergoing surgery for the adult spinal deformity (ASD).Corrective surgery for ASD has increased, especially in older persons. However, perioperative complication rates remain high in ASD surgery, including cardiopulmonary complications.This study included patients with ASD who underwent surgery between May 2016 and April 2018. A cardiologist performed all echocardiography imaging preoperatively and 2 weeks postoperatively. Left ventricular contractility was measured using left ventricular ejection fraction (LVEF), and right ventricular contractility was measured using tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular peak systolic velocity (S'). Spinopelvic radiographic parameters, the apices of thoracic kyphosis and lumbar lordosis, and the inflection point where the vertebral curvature changes from kyphosis to lordosis were also measured. Differences between preoperative and postoperative measurements for continuous variables were analyzed using a paired Student t test. Differences in continuous and categorical variables between two independent groups were analyzed using an unpaired Student t test and Fisher exact test, respectively. Multivariate logistic regression analyses were performed to detect influential factors.Sixty-one patients were included [12 males and 49 females; average age, 64.0 (22-84) yr]. LVEF, TAPSE, and S', respectively changed from 64.4%, 24.9 mm, and 14.3 cm/s to 65.4%, 25 mm, and 15 cm/s postoperatively with no significance. However, in LVEF<59.3% (average-1 SD), TAPSE<17 mm, and S'<11.8 cm/s cases, respectively, these increased significantly from 55.7%, 17.9 mm, and 10.5 cm/s to 60.9%, 21.4 mm, and 14.2 cm/s postoperatively ( P =0.036, 0.029, and 0.022, respectively). The LVEF<59.3% group showed a significantly lower inflection point level (1.5 vs. 2.9) preoperatively ( P =0.007). The S'<11.8 cm/s group showed significantly larger thoracic kyphosis (28.3° vs. 19.4°) preoperatively ( P =0.013).Perioperative cardiac function did not deteriorate after surgery in patients with ASD. In those with lower cardiac function preoperatively, there were significant improvements noted postoperatively. The preoperative inflection point level was significantly lower in the lower LVEF group. Preoperative thoracic kyphosis was significantly larger in the lower tricuspid annular peak systolic velocity group.
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