Akademik Veri Yönetim Sistemi
FRONTIERS IN MEDICINE, cilt.2, sa.1, ss.1-7, 2023 (SCI-Expanded)
Objective: This study aimed to demonstrate the reliability of the cardiac cycle
efficiency value through its correlation with longitudinal strain by observing the
effect of the deep Trendelenburg position.
Design: A prospective, observational study.
Setting: Single center.
Participants: Between May and September 2022, the hemodynamic parameters
of 30 patients who underwent robotic assisted laparoscopic prostatectomy under
general anesthesia were prospectively evaluated.
Measurements and main results: All invasive cardiac monitoring parameters and
longitudinal strain achieved transesophageal echocardiography were recorded in
pre-deep Trendelenburg position (T3) and 10th minute of deep Trendelenburg
position (T4). Delta values were calculated for the cardiac cycle efficiency and
longitudinal strain (values at T4 minus values at T3). The estimated power was
calculated as 0.99 in accordance with the cardiac cycle efficiency values at T3
and T4 (effect size: 0.85 standard deviations of the mean difference: 0.22, alpha:
0.05). At T4, heart rate, pulse pressure variation, cardiac cycle efficiency, dP/dt
and longitudinal strain were significantly lower than those at T3 (p = 0.009,
p < 0.001, p < 0.001, and p < 0.001, respectively). There was a positive
correlation between the delta-cardiac cycle efficiency and delta-longitudinal
strain (R
2 = 0.36, p < 0.001).
Conclusion: Although the absence of significant changes in mean arterial
pressure and cardiac index after Trendelenburg position suggests that cardiac
workload has not changed, changes in cardiac cycle efficiency and longitudinal
strain indicate increased cardiac workload due to increased ventriculoarterial coupling.
KEYWORDS
general anesthesia, cardiac efficiency, arterial elastance, ventriculo-arterial coupling,
hemodynamic monitoring