Effect on the left ventricular dysfunction in the early postoperative period following off-pump coronary artery bypass grafting of type 2 diabetes mellitus underlying sufentanil coronary perfusion against ischemia-reperfusion injury by speckle tracking transesophageal echocardiography

Abstract

Objective To assess sufentanil postconditioning against ischemia-reperfusion injury whether left ventricular systolic deformation in the early postoperative period could be estimated by speckle tracking transesophageal echocardiography (STTE) / averaged global longitudinal peak systolic strain (aGLPS) in monitoring and treatment of type 2 diabetes mellitus (T2DM)-cardiovascular disease (CVD) co-morbidity or CVD by off-pump coronary artery bypass grafting (OPCABG). Methods 2D-STTE cine-loops for off-line speckle tracking analysis were obtained from 40 patients (group CVD and group T2DM-CVD,sufentanil postconditioning against ischemia-reperfusion injury after coronary artery bypass grafting,n=20).STEE/aGLPS study:the analysis of 2D strain was performed offline,using a semiautomatic tracking of LV.After manually tracking the endocardial border on a 2D image end-systolic frame,the software automatically tracked myocardial motion,creating six equidistant speckle tracking regions of interest for each image at isochronal time points (T0,Suf-PoC0 min; T1,Suf-PoC30 min; T2,Suf-PoC2 h; T3,Suf-PoC4 h; T4,Suf-PoC6 h).Heart rate (HR),mean arterial pressure (MAP),central venous pressure (CVP),cardiac index (CI),stroke volume (SV),and left ventricular ejection fraction (LVEF) were monitored by FloTrac/Vigileo and Philips M6 Multi-Function Monitor in type of two patients undergoing OPCABG. Results There are no significant differences in the general characteristics of the two groups except for glucose concentration.But the averaged Global Peak Strain (aGLPS) reduced in group T2DM-CVD than group CVD 2 h after sufentanil postconditioning (T2-T4 after coronary recanalization) in cardiac surgery (P＜0.05),which is adaptable for other monitoring of left ventricular systolic function [ Group T2DM-CVD:aGLPST0,( -13.4±2.2 )％; aGLPST1,( -17.0±2.4 )％; aGLPST2,( -17.3±3.1 )％ ;aGLPST3, ( -14.6±2.6)％ ; aGLPST4,(-14.7±1.7)％.Group CVD:aGLPST0,(-13.1 ±2.4)％ ; aGLPST1,(-16.4±3.1)％ ; aGLPST2,( -19.6±3.4)％; aGLPST3,(-20.3±2.6)％; aGLPST4,(-20.4±1.9)％ ]. Conclusions STTFE/aGLPS can be regarded to evaluate the global left ventricular systolic function,which is very valuable in monitoring and treatment of OPCABG.Further research is needed to develop the evidence-based clinical practice that T2DM attenuates the effects of cardioprotection by sufentanil postconditioning against ischemia-reperfusion injury. Key words: Speckle tracking transesophageal echocardiography; Averaged global longitudinal peak systolic strain; Offpump coronary artery bypass grafting; Opioid-postconditioning; Sufentanil; Type 2 diabetes mellitus