Abstract:

Aim: was to evaluate the influence of factors on the development of diaphragmatic dysfunction ir early periods after cardiac surgery

Materials and methods: study included 830 patients after various cardiac surgery in Federal National Center of Cardiovascular Surgery (Penza, Russian Federation). In the early postoperative period (3,9 ± 0,9 days) all patients underwent chest x-ray while transporting from intensive care unit. We evaluated differences between diaphragm contors in two consecutive shots - with a deep breath and exhale fully In the early postoperative period diaphragmatic dysfunction was detected in 172 cases (20.7%). Patients were divided into 4 groups depending on the presence or absence of a violation of the diaphragm function. The criterion of selection into the group with diaphragmatic dysfunction was size of amplitude motion, less than 10 mm. 1st group with normal mobility of the diaphragm included 658 patients (79.3%). 2nd group with dysfunction of the left dome of the diaphragm - 85 patients(10.2%). 3rd group with dysfunction of the right dome - 58 patients (7%). 4th group with bilateral diaphragmatic dysfunction - 29 patients (3.5%). Logistic regression model included 4 variables, the significance of which is reflected by the published data: preparation of internal thoracic artery (ITA) for graft, valve surgery, the use of radiofrequency ablation, the use of cardiopulmonary bypass. We made a multiple logistic regressive analysis of predictors for the development of diaphragmatic dysfunction.

Results: we have found that under the influence of complex predictors, greatest chance of dysfunction was observed in the group with bilateral violation of diaphragm mobility after two-sidec separation of ITA (OR 3.4; CI 1.60, 7.25). High chances of dysfunction were observed in groups with unilateral violation of diaphragm mobility after unilateral separation of ITA. Separation of left ITA had higher chances for diaphragmal dysfunction (OR 2.7; CI 1.36; 5.37) than in case of separation of right ITA (OR 2.0; CI 1.16, 3.47). After valve operations, radiofrequency ablation, and cardiopulmonary bypass chances of diaphragmatic dysfunction was statistically insignificant (p>0.05) in all study groups.

Conclusions: diaphragmatic dysfunction develops in 3.4 times greater in case of bilateral separation of ITA. Unilateral dysfunction of the diaphragm has a great chance in case of separation of ITA: left up to 2.7 times and right up to 2 times. Influence of cardiopulmonary bypass, valve operations and radiofrequency ablation for the development of diaphragmatic dysfunction is statistically insignificant.

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Abstract:

Aim: was to determine what dimensions of an end-diastolic volume (EDV) in patients with reducec left ventricular function (LV) higher chances to measure its value up to 50 ml with Echocardiography compared to MRI.

Materials and methods: the sample consisted of 134 patients with ischemic cardiomyopathy and ejection fraction (EF) less than 35%. A mathematical model that calculates what dimensions of the MLC are more likely to determine its size with an accuracy of up to 50 ml with Echocardiography compared to MRI. Produced logistic regression analysis and calculated odds ratios.

Results: аccording to Echocardiography the EDV was 250.5 ± 67.6 ml, EF was 29.4 ± 5.0 percent. According to MRI, the EDV was 249.3 ± 77.2 ml, EF was 29.9 ± 6.4 percent. Results of the logistic regression analysis showed that EDV to 150 ml have high chances of a consistent measure of EDV with Echocardiography and MRI (OR a 2,5). In groups with EDV more than 150 ml but less than 300 ml had low chances of an accurate measurement of the EDV at the Echocardiography (OR from 0,62 to 0,95). Since EDV is greater than 300 ml, a marked increase chances Echocardiography, to determine EDV up to 50 ml compared to MRI (OR from 2,3 to 4,2).

Conclusions: when EDV to 150 ml, and in dilatation of the left ventricle more than 300 ml MRI has no advantages compared to Echocardiography In these figures there is no need to duplicate echocardiographic study When the EDV of 150 to 300 ml, for determination of volumetric indices it is better to use MRI, because the computations do not depend on the geometric shape of the left ventricle.

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