Perioperative Echokardiografie der rechts- und linksventrikulären Funktion

Zusammenfassung

Die Echokardiografie erlaubt eine präzise und minimalinvasive Charakterisierung der rechtsventrikulären (RV) und linksventrikulären (LV) Funktion chirurgischer Patientinnen und Patienten. Eine korrekte Handhabung und ein fundiertes Verständnis der Messungen sind unabdingbar für eine valide echokardiografische Untersuchung. Im folgenden Beitrag werden die gängigsten, aber auch einige neue Parameter der RV- und LV-Funktion vorgestellt.

Abstract

The perioperative quantification of left and right ventricular function is cornerstone to provide optimal patient care. Echocardiography has emerged as the most important cardiac imaging modality in this setting, mainly due to its rapid availability, non-invasiveness and cost-efficiency. Both the transthoracic and the transesophageal acoustic windows offer manifold modes, e.g., doppler-based measurements or M-mode display, to assess systolic and diastolic ventricular function. An association with patient outcome and corresponding prognostic implications could be demonstrated for the majority of those parameters. Hence, a profound understanding of these measurements is key to delineate sufficient from failing left or right ventricular function and guide treatment decisions. This article gives the reader an overview over the most important measurements, reference values and pitfalls.

Schlüsselwörter

perioperative Echokardiografie - rechter Ventrikel - linker Ventrikel - systolische Funktion - diastolische Funktion

Key words

perioperative echocardiography - right ventricle - left ventricle - systolic function - diastolic function

• Literatur

• 1 Shillcutt SK, Markin NW, Montzingo CR. et al. Use of rapid “rescue” perioperative echocardiography to improve outcomes after hemodynamic instability in noncardiac surgical patients. J Cardiothorac Vasc Anesth 2012; 26: 362-370
• 2 Lenk T, Whittle J, Miller TE. et al. Focused cardiac ultrasound in preoperative assessment: the perioperative providerʼs new stethoscope?. Perioper Med (Lond) 2019; 8: 16
• 3 MacKay EJ, Zhang B, Heng S. et al. Association between transesophageal echocardiography and clinical outcomes after coronary artery bypass graft surgery. J Am Soc Echocardiogr 2021; 34: 571-581
• 4 Hahn RT, Abraham T, Adams MS. et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2013; 26: 921-964
• 5 Hilberath JN, Oakes DA, Shernan SK. et al. Safety of transesophageal echocardiography. J Am Soc Echocardiogr 2010; 23: 1115-1127 quiz 1220-1221
• 6 Flu WJ, van Kuijk JP, Hoeks SE. et al. Prognostic implications of asymptomatic left ventricular dysfunction in patients undergoing vascular surgery. Anesthesiology 2010; 112: 1316-1324
• 7 Lang RM, Badano LP, Mor-Avi V. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28: 1-39.e14
• 8 Nagueh SF, Smiseth OA, Appleton CP. et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29: 277-314
• 9 Aurich M, Andre F, Keller M. et al. Assessment of left ventricular volumes with echocardiography and cardiac magnetic resonance imaging: real-life evaluation of standard versus new semiautomatic methods. J Am Soc Echocardiogr 2014; 27: 1017-1024
• 10 Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart 2014; 100: 1673-1680
• 11 Benson MJ, Silverton N, Morrissey C. et al. Strain Imaging: An everyday tool for the perioperative echocardiographer. J Cardiothorac Vasc Anesth 2020; 34: 2707-2717
• 12 Swaminathan M, Nicoara A, Phillips-Bute BG. et al. Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery. Ann Thorac Surg 2011; 91: 1844-1850
• 13 Nagueh SF, Middleton KJ, Kopelen HA. et al. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 1997; 30: 1527-1533
• 14 Keller M, Heller T, Lang T. et al. Acute changes of global and longitudinal right ventricular function: an exploratory analysis in patients undergoing open-chest mitral valve surgery, percutaneous mitral valve repair and off-pump coronary artery bypass grafting. Cardiovasc Ultrasound 2020; 18: 32
• 15 Wang TKM, Grimm RA, Rodriguez LL. et al. Defining the reference range for right ventricular systolic strain by echocardiography in healthy subjects: A meta-analysis. PLoS One 2021; 16: e0256547
• 16 Ternacle J, Berry M, Cognet T. et al. Prognostic value of right ventricular two-dimensional global strain in patients referred for cardiac surgery. J Am Soc Echocardiogr 2013; 26: 721-726
• 17 Keller M, Heller T, Duerr M-M. et al. Association of 3D mesh-derived right ventricular strain with short-term outcome in patients undergoing cardiac surgery. J Am Soc Echocardiogr 2021;
• 18 Greiner S, Jud A, Aurich M. et al. Reliability of noninvasive assessment of systolic pulmonary artery pressure by Doppler echocardiography compared to right heart catheterization: analysis in a large patient population. J Am Heart Assoc 2014; 3: e001103