Study On The Correlation Between Left Ventricular Short Axis Papillary Muscle Plane Area And Volume Response By Transthoracic Echocardiography

Objective: The respiratory variability of the stroke volume of the left ventricle or its alternative index is a good predictor of fluid responsiveness in mechanically ventilated patients.Echocardiography can measure the changes in the area of the heart in real time.It has been proven that the area and volume have a good correlation.This study intends to explore the application value of the area-related indicators of the left ventricular short-axis papillary muscle section in the perioperative patient volume status and responsiveness.Methods: The study included 52 patients who underwent elective gastrointestinal surgery from September 2019 to March 2020,and the patients were infused with 250 ml colloidal fluid within 10 minutes.Record the patient’s gender,BMI,cardiac color Doppler ultrasound ejection fraction(EF),ASA classification and end-respiratory carbon dioxide and other general clinical data.All patients used the same drugs and ventilation methods,and recorded changes in various values before and after rehydration.The area variation(△SA)of the short-axis papillary muscle plane of the left ventricle was measured by TTE during three breathing cycles,and the stroke volume of the patient was measured by a hemodynamic analyzer to calculate the △SV.Hemodynamic analysis calculated △SV≥15% as the volume response grouping standard,from which the relevant data was compared and the correlation degree of each index in the study was analyzed.Results: Among 52 patients,29 were in the positive volume reaction group and 23 were in the negative volume reaction group.Before and after the fluid rehydration test,there were statistical differences in heart rate,systolic blood pressure,and diastolic blood pressure between the two groups(P<0.05);stroke volume(SV)and left ventricular short-axis area changes(SA)were also different in the two groups of heart related indicators It was statistically significant(P<0.05).In the negative reaction group,the difference in ejection fraction(EF)and heart rate was not statistically significant.There was a statistically significant difference in the left ventricular short-axis enddiastolic area(LVEDA)between the two groups of patients before fluid supplementation,but there was no significant difference in LVEDA after fluid supplementation.Comparison of the change indexes of the two groups before and after fluid infusion,among which ΔSV and ΔSA were statistically different(P <0.01),heart rate changes(ΔHR)were statistically different(P <0.05),blood pressure changes(ΔMAP)and diastolic area changes(ΔLVEDA)There was no statistical difference.The ΔMAP before and after the rehydration test is statistically analyzed,and the area under the ROC curve is 0.579±0.082.The 95% confidence interval for this index analysis is 0.419-0.740,where the P value is equal to 0.329;the ΔHR before and after the rehydration is statistically analyzed.The area under the ROC curve is 0.331±0.075,and the 95% confidence interval of this index analysis is 0.185-0.478,where the P value is equal to 0.038;statistical analysis of another index of short axis ultrasound,ΔLVEDA,shows that the area under the ROC curve of this index is 0.583± 0.080,the 95% confidence interval of this indicator analysis is 0.427-0.739,where the P value is equal to 0.307.△SV is used as the grouping standard in the experiment,and the area under the ROC curve is 1,so the 95% confidence interval of this indicator analysis is 1.000-1.000,where P<0.01.△SA is the main observation index in the study.The area under the ROC curve is 0.944.The 95% confidence interval for this index analysis is 0.886-1.000.The analysis of this index is P<0.01.At the same time,the research shows that when △SA takes the result to be 16.75% At the time,the sensitivity of the result to the capacity prediction effect was 93%,and the specificity was 83%.There is a positive correlation between △SV and △SA,the Person correlation coefficient is 0.807,P<0.01.Conclusion: 1.Heart rate changes and mean arterial pressure changes have low value in predicting volume responsiveness.2.The short-axis end-diastolic area change(ΔLVEDA)is not of high value for capacity prediction.3.Left ventricular short-axis papillary muscle area variation(△SA)can be used as a predictor of volume response.