Comparison of left ventricular ejection fraction obtained by using 3D echo modality called 3D EPSS with currently practiced methods of echo 2D EPSS, and 2D simpsons and 3D volumetric methods.
- Conditions
- Atherosclerotic heart disease of native coronary artery,
- Registration Number
- CTRI/2023/07/055283
- Lead Sponsor
- Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum
- Brief Summary
Estimation of left ventricular ejection (LVEF) fraction is an integral part of assessment of LV systolicfunction and most commonly used to assess LV systolic function, and the reduction of LVEF is seen to be associate with decreased survival rate(4).The gold standard for assessment of LVEF is using Cardiac MR(CMR) . Estimation of LVEF using modified Simpson’s biplane technique is routinely performed during cardiac surgery in the pre and post cardiopulmonary bypass period and is the currently the only recommended method for calculation of LVEF using TEE. Off all the different echo modalities used for assessment of EF, compared to CMR, 3DE currently offers the closest approximation. 3DE uses volumetric approach for acquisition of data , its visualization and quantification. This allows distance between 2 structures to be measured more accurately. Mitral EPSS is largely utilized in the emergency care for quick and reliable assessment of EF. EPSS was initially studied in 1970s as easily measured, quantitative index of LV function with a good reproducibility Elagha A et al. studied Mitral EPSS by CMR and found that EPSS measurement by CMR is reliable and easy to perform and allows parallel assessment of LV function in both normal patients and patients having myocardial fibrosis.Cosansu et al. was able to prove that the ratio of left ventricular internal diameter in diastole(LVIDd) with EPSS or LVIDd/EPSS was able to predict advanced HF and cases with EF<40% more accurately .Area of separation of mitral valve from LV septal wall can be measured on 3DE. 3DE assessment of mitral EPSS and EPSS area has a potential to predict LVEF more accurately and currently remains an unstudied territory.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Completed
- Sex
- Male
- Target Recruitment
- 50
All adults above 18 years of age, in sinus rhythm, admitted with CAD for elective CABG surgery will be included in the study.
- Emergency surgeries 2.
- Redo surgeries 3.
- Patients not willing to participate in study 4.
- More than mild AR, MR or TR 5.
- Patients with Mitral valve pathology causing restricted or increased mobility of leaflets 6.
- Patients receiving preoperative inotropes 7.
- Patients with poor echo differentiation of endocardial borders 8.
- Patient with arrhythmias.
- Contraindication to TEE probe placement like esophageal strictures, esophageal varices, esophageal tumors, gastric ulcer, previous esophagectomy, esophageal diverticulum, tracheoesophageal fistula, previous bariatric surgery, hiatus hernia, large descending thoracic aortic aneurysm, unilateral vocal cord paralysis, esophageal varices, post-radiation therapy.
Study & Design
- Study Type
- Observational
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method from modified Simpson’s formula in patients with normal LV systolic function (LVEF more than 52% in Pre CPB initiation men & 54% in women) & their correlation with LVEF obtained by 3DE volumetric assessment as a reference method. Pre CPB initiation 1. Comparison of 2D mitral EPSS-based LVEF & 3D mitral EPSS-based LVEF with 2D LVEF measured Pre CPB initiation good LV & deranged LV function. We also would try to derive a formula to calculate LVEF using 3D Pre CPB initiation 2. Correlation of 3D mitral EPSS area with 2DE modified Simpson’s LVEF & 3DE LVEF in patients with Pre CPB initiation EPSS area. Pre CPB initiation
- Secondary Outcome Measures
Name Time Method 1. Comparison of LVEF obtained by 2D & 3D mitral EPSS, modified Simpson’s formula and their correlation with LVEF obtained by 3DE volumetric assessment as a reference method.
Trial Locations
- Locations (1)
Sree Chitra Tirunal Institute for Medical Sciences and Technology
🇮🇳Thiruvananthapuram, KERALA, India
Sree Chitra Tirunal Institute for Medical Sciences and Technology🇮🇳Thiruvananthapuram, KERALA, IndiaV Krishna Narayanan NayanarPrincipal investigator9419654756krishna3827@gmail.com