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Master Thesis

Caractérisation par STRAIN des effets myocardiques du remplissage vasculaire

Abstract : Background: the main objective of volume expansion is to increase stroke volume (VES). According to Frank Starling's law, the improvement in VES induced by an increase in preload is due to an improvement in contractility. Strain analysis allows assessment of contractility and is more sensitive than conventional ultrasound assessment of left ventricular ejection fraction. Few data are available on the potential interest of speckle tracking to follow an improvement in left ventricular contractility following perioperative volume expansion. The objective of this study was to evaluate changes in global longitudinal strain value of the left ventricle during volume expansion (500mL crystalloid) in patients with and without response to volume expansion. Methods: we conducted a single-center prospective observational study of postoperative patients. Patients requiring volume expansion will have echocardiography (assessment of stroke volume and longitudinal strain) before and after fluid challenge (500mL crystalloid). The primary end point was the change in global left ventricular longitudinal strain value in patients who responded to volume expansion (15% or more increase in stroke volume). Secondary end point was changes in global left ventricular longitudinal strain value in patients who did not respond to volume expansion. Results: among 64 postoperative neurosurgical patients, images were sufficiently accurate to analyze strain in 40 patients. Volume expansion was associated with significant improvement in GLS in responders only (-21%; 95% CI,-23 - -19 vs -22%; 95% CI,-25 - -20; p<0.01). LVEF did not change after fluid administration. Conclusions: the current study suggests that volume expansion induces significant changes in GLS in responder patients but not in non-responders. GLS should be interpreted according to loading conditions only in preload-dependent patients.
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https://dumas.ccsd.cnrs.fr/dumas-03528672
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Submitted on : Monday, January 17, 2022 - 1:16:10 PM
Last modification on : Wednesday, January 19, 2022 - 3:38:27 AM
Long-term archiving on: : Monday, April 18, 2022 - 8:35:36 PM

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Jean-Philippe Vest. Caractérisation par STRAIN des effets myocardiques du remplissage vasculaire. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03528672⟩

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