Incidence and factors associated with pericardial effusion after cardiac valve surgery

Introduction: Pericardial effusion (PE) is a postoperative complication of cardiac valve surgery, related to early hospital readmissions and death. We aimed to describe its incidence and to identify predictive factors of moderate-to-severe PE in a contemporary cohort. Methods: We retrospectively reviewed medical records of all consecutive patients submitted to cardiac valve surgery in a tertiary teaching hospital from January 2012 to July 2014, where echocardiography was routinely performed before patient discharge. Moderate-to-severe PE was defined as ≥ 10 mm of thickness, or signs of cardiac tamponade on echocardiography. Additional clinical and perioperative data were extracted from medical records using a standardized protocol. Results: Of 353 patients, 335 underwent a predischarge echocardiography. From these, 27 patients (8%; mean age: 62 years; standard deviation 12 years; 70% male) had moderate-to-severe PE. These patients had a higher prevalence of previous stroke (22% vs. 8%; p = 0.009) and oral anticoagulation (international normalized ratio > 2) prior to the surgery (11 vs. 2%; P = 0.002). In patients with moderate-to-severe PE, surgeries had longer ischemia (p < 0.001) and cardiopulmonary bypass (p < 0.001) times, and the prevalence of postoperative atrial fibrillation was higher (56% vs. 32%; p = 0.011) than in patients with absent or small PE. Hospital mortality was also higher (15% vs. 3%; p = 0.002) in patients with moderate-to-severe PE. Conclusions: Eight percent of patients submitted to cardiac valve surgery developed moderate-to-severe PE. Moreover, PE was associated with pre- and post-surgery conditions likely related to the coagulation state, though a cause-effect relationship could not be inferred. Noteworthy, this condition was associated with higher in-hospital morbidity and mortality.Keywords: Adult; pericardium; postoperative car

Reproducibility of left ventricular global longitudinal strain using two-dimensional ultrasound speckle tracking : Longitudinal Study of Adult Health (ELSA-Brasil)

Introducción Se han propuesto técnicas ecocardiográficas avanzadas como el strain longitudinal global por ecocardiografía bidimensional speckle tracking para la detección de alteraciones precoces de la función sistólica del ventrículo izquierdo. La evaluación de la reproducibilidad del strain longitudinal global es fundamental para su aplicación clínica en diferentes escenarios. Objetivo Estimar la reproducibilidad del strain longitudinal global del ventrículo izquierdo en individuos de un estudio de cohorte del Brasil. Métodos La reproducibilidad del strain longitudinal global del ventrículo izquierdo fue evaluada mediante lectura y análisis de imágenes de ecocardiografía de una muestra aleatoria de 50 participantes de la línea de base del Estudio Longitudinal de Salud del Adulto (ELSA-Brasil). Resultados Los participantes tenían una edad promedio de 49,7 ± 7,3 años, 54% eran mujeres y la media del strain longitudinal global fue –19,5% ± 1,9%. La reproducibilidad interobservador de la medida del strain longitudinal global mostró un coeficiente de variación de 7,4% y un coeficiente de correlación intraclase de 0,76 (IC 95%: 0,61, 0,86). El análisis del acuerdo interobservador de las medidas del strain longitudinal global mediante el método de Bland & Altman evidenció un promedio de diferencias de 0,1% ± 1,4% y unos límites de acuerdo superior de 2,9 e inferior de –2,7. Conclusiones Hubo una reproducibilidad adecuada de las medidas del strain longitudinal global del ventrículo izquierdo en participantes del ELSA-Brasil y los valores fueron similares a los reportados en otros estudios epidemiológicos longitudinales. Los hallazgos refuerzan la utilidad del strain longitudinal global como un índice clínico de deformación miocárdica, capaz de detectar alteraciones subclínicas de la contractilidad miocárdica.Introduction Advanced echocardiography techniques, such as the global longitudinal strain using two-dimensional ultrasound speckle tracking, have been proposed for the detection of early changes in the left ventricular systolic function. The evaluation of the reproducibility of left ventricular global longitudinal strain is essential for its clinical application in different scenarios. Objective To determine the reproducibility of left ventricular global longitudinal strain in individuals from a Brazil cohort study. Methods The reproducibility of left ventricular global longitudinal strain was evaluated by the reading and analysis of echocardiograph images of a random sample of 50 participants of the baseline Longitudinal Study of Adult Health (ELSA-Brasil). Results The mean age of the participants was 49.7 ± 7.3 years, of whom 54% were women, and the mean global longitudinal strain was –19.5% ± 1.9%. The inter-observer reproducibility of the mean global longitudinal strain, had a coefficient of variation of 7.4%, and an intra-class correlation of 0.76 (95% CI: 0.61 – 0.86). The analysis of the inter-observer agreement of the global longitudinal strain measurements using the Bland and Altman method showed a mean differences of 0.1% ± 1.4%, and upper and lower limits of agreement of 2.9 and –2.7, respectively. Conclusions There was adequate reproducibility of the left ventricular global longitudinal strain measurements in participants of the ELSA-Brasil study, and the values were similar to those reported in other longitudinal epidemiological studies. The findings reinforce the use of the global longitudinal strain as a clinical marker of myocardial deformation, capable of detecting subclinical changes in myocardial contractility

Incidence and factors associated with pericardial effusion after cardiac valve surgery

Introduction: Pericardial effusion (PE) is a postoperative complication of cardiac valve surgery, related to early hospital readmissions and death. We aimed to describe its incidence and to identify predictive factors of moderate-to-severe PE in a contemporary cohort. Methods: We retrospectively reviewed medical records of all consecutive patients submitted to cardiac valve surgery in a tertiary teaching hospital from January 2012 to July 2014, where echocardiography was routinely performed before patient discharge. Moderate-to-severe PE was defined as ≥ 10 mm of thickness, or signs of cardiac tamponade on echocardiography. Additional clinical and perioperative data were extracted from medical records using a standardized protocol. Results: Of 353 patients, 335 underwent a predischarge echocardiography. From these, 27 patients (8%; mean age: 62 years; standard deviation 12 years; 70% male) had moderate-to-severe PE. These patients had a higher prevalence of previous stroke (22% vs. 8%; p = 0.009) and oral anticoagulation (international normalized ratio > 2) prior to the surgery (11 vs. 2%; P = 0.002). In patients with moderate-to-severe PE, surgeries had longer ischemia (p < 0.001) and cardiopulmonary bypass (p < 0.001) times, and the prevalence of postoperative atrial fibrillation was higher (56% vs. 32%; p = 0.011) than in patients with absent or small PE. Hospital mortality was also higher (15% vs. 3%; p = 0.002) in patients with moderate-to-severe PE. Conclusions: Eight percent of patients submitted to cardiac valve surgery developed moderate-to-severe PE. Moreover, PE was associated with pre- and post-surgery conditions likely related to the coagulation state, though a cause-effect relationship could not be inferred. Noteworthy, this condition was associated with higher in-hospital morbidity and mortality. Keywords: Adult; pericardium; postoperative car

Incidence and factors associated with pericardial effusion after cardiac valve surgery

Introduction: Pericardial effusion (PE) is a postoperative complication of cardiac valve surgery, related to early hospital readmissions and death. We aimed to describe its incidence and to identify predictive factors of moderate-to-severe PE in a contemporary cohort. Methods: We retrospectively reviewed medical records of all consecutive patients submitted to cardiac valve surgery in a tertiary teaching hospital from January 2012 to July 2014, where echocardiography was routinely performed before patient discharge. Moderate-to-severe PE was defined as ≥ 10 mm of thickness, or signs of cardiac tamponade on echocardiography. Additional clinical and perioperative data were extracted from medical records using a standardized protocol. Results: Of 353 patients, 335 underwent a predischarge echocardiography. From these, 27 patients (8%; mean age: 62 years; standard deviation 12 years; 70% male) had moderate-to-severe PE. These patients had a higher prevalence of previous stroke (22% vs. 8%; p = 0.009) and oral anticoagulation (international normalized ratio > 2) prior to the surgery (11 vs. 2%; P = 0.002). In patients with moderate-to-severe PE, surgeries had longer ischemia (p < 0.001) and cardiopulmonary bypass (p < 0.001) times, and the prevalence of postoperative atrial fibrillation was higher (56% vs. 32%; p = 0.011) than in patients with absent or small PE. Hospital mortality was also higher (15% vs. 3%; p = 0.002) in patients with moderate-to-severe PE. Conclusions: Eight percent of patients submitted to cardiac valve surgery developed moderate-to-severe PE. Moreover, PE was associated with pre- and post-surgery conditions likely related to the coagulation state, though a cause-effect relationship could not be inferred. Noteworthy, this condition was associated with higher in-hospital morbidity and mortality

Reproducibilidad del strain longitudinal global del ventrículo izquierdo por ecocardiografía bidimensional speckle tracking: Estudio Longitudinal de Salud del Adulto (ELSA-Brasil)

Resumen: Introducción: Se han propuesto técnicas ecocardiográficas avanzadas como el strain longitudinal global por ecocardiografía bidimensional speckle tracking para la detección de alteraciones precoces de la función sistólica del ventrículo izquierdo. La evaluación de la reproducibilidad del strain longitudinal global es fundamental para su aplicación clínica en diferentes escenarios. Objetivo: Estimar la reproducibilidad del strain longitudinal global del ventrículo izquierdo en individuos de un estudio de cohorte del Brasil. Métodos: La reproducibilidad del strain longitudinal global del ventrículo izquierdo fue evaluada mediante lectura y análisis de imágenes de ecocardiografía de una muestra aleatoria de 50 participantes de la línea de base del Estudio Longitudinal de Salud del Adulto (ELSA-Brasil). Resultados: Los participantes tenían una edad promedio de 49,7 ± 7,3 años, 54% eran mujeres y la media del strain longitudinal global fue â19,5% ± 1,9%. La reproducibilidad interobservador de la medida del strain longitudinal global mostró un coeficiente de variación de 7,4% y un coeficiente de correlación intraclase de 0,76 (IC 95%: 0,61, 0,86). El análisis del acuerdo interobservador de las medidas del strain longitudinal global mediante el método de Bland & Altman evidenció un promedio de diferencias de 0,1% ± 1,4% y unos límites de acuerdo superior de 2,9 e inferior de â2,7. Conclusiones: Hubo una reproducibilidad adecuada de las medidas del strain longitudinal global del ventrículo izquierdo en participantes del ELSA-Brasil y los valores fueron similares a los reportados en otros estudios epidemiológicos longitudinales. Los hallazgos refuerzan la utilidad del strain longitudinal global como un índice clínico de deformación miocárdica, capaz de detectar alteraciones subclínicas de la contractilidad miocárdica. Abstract: Introduction: Advanced echocardiography techniques, such as the global longitudinal strain using two-dimensional ultrasound speckle tracking, have been proposed for the detection of early changes in the left ventricular systolic function. The evaluation of the reproducibility of left ventricular global longitudinal strain is essential for its clinical application in different scenarios. Objective: To determine the reproducibility of left ventricular global longitudinal strain in individuals from a Brazil cohort study. Methods: The reproducibility of left ventricular global longitudinal strain was evaluated by the reading and analysis of echocardiograph images of a random sample of 50 participants of the baseline Longitudinal Study of Adult Health (ELSA-Brasil). Results: The mean age of the participants was 49.7 ± 7.3 years, of whom 54% were women, and the mean global longitudinal strain was â19.5% ± 1.9%. The inter-observer reproducibility of the mean global longitudinal strain, had a coefficient of variation of 7.4%, and an intra-class correlation of 0.76 (95% CI: 0.61 â 0.86). The analysis of the inter-observer agreement of the global longitudinal strain measurements using the Bland and Altman method showed a mean differences of 0.1% ± 1.4%, and upper and lower limits of agreement of 2.9 and â2.7, respectively. Conclusions: There was adequate reproducibility of the left ventricular global longitudinal strain measurements in participants of the ELSA-Brasil study, and the values were similar to those reported in other longitudinal epidemiological studies. The findings reinforce the use of the global longitudinal strain as a clinical marker of myocardial deformation, capable of detecting subclinical changes in myocardial contractility. Palabras clave: Reproducibilidad de resultados, Strain longitudinal, Contracción miocárdica, Ecocardiografía, Keywords: Reproducibility of results, Longitudinal strain, Myocardial contraction, Echocardiograph