Monitoring systemic ventriculoarterial coupling after cardiac surgery using continuous transoesophageal...

Area of Science:

• Cardiovascular Physiology
• Medical Technology
• Artificial Intelligence in Medicine

Background:

• Ventriculoarterial coupling is crucial for cardiovascular and left ventricular function.
• Deterioration in this coupling can have severe consequences.
• Continuous monitoring of left ventricular function is needed, especially post-cardiac surgery.

Purpose of the Study:

• To develop and validate autoMAPSE, a novel tool for automatic measurement of mitral annular plane systolic excursion (MAPSE) using transesophageal echocardiography and deep learning.
• To assess if autoMAPSE can monitor systemic ventriculoarterial coupling and detect changes in postoperative cardiac biomarkers.
• To evaluate the relationship between autoMAPSE, ventriculoarterial coupling indices, and cardiac biomarkers (ProBNP, TnT) in the early postoperative period.

Main Methods:

• Fifty patients undergoing cardiac surgery were monitored for 120 minutes postoperatively.
• autoMAPSE measurements and mean arterial pressure (MAP) were recorded every 5 minutes.
• Ventriculoarterial coupling was assessed using the arterial elastance to end-systolic elastance ratio (Ea/Ees).
• Postoperative N-terminal pro B-type natriuretic peptide (ProBNP) and high-sensitivity troponin-T (TnT) levels were measured.
• Statistical analyses included correlation and linear mixed-effects models to assess relationships.

Main Results:

• autoMAPSE showed a significant negative correlation with the Ea/Ees ratio, indicating its ability to reflect ventriculoarterial coupling.
• Individual patient data revealed significant heterogeneity in the relationship between autoMAPSE and MAP, highlighting personalized coupling dynamics.
• Continuous autoMAPSE measurements were negatively correlated with peak postoperative ProBNP and troponin-T levels.
• The tool demonstrated effectiveness in reflecting ventriculoarterial coupling and predicting cardiac biomarker levels.

Conclusions:

• The autoMAPSE tool provides continuous, non-invasive monitoring of left ventricular function and ventriculoarterial coupling post-cardiac surgery.
• Early postoperative autoMAPSE measurements correlate with key cardiac biomarkers (ProBNP, TnT) over the subsequent 24 hours.
• autoMAPSE shows promise as a valuable tool for real-time assessment and management of cardiovascular function in the critical postoperative period.