Sabit SARİKAYA, Fuat BÜYÜKBAYRAK, İbrahim UYAR, Özer SELİMOĞLU, Deniz GÜNAY, Mete ALP, Eray AKSOY

An evaluation of diagnostic sensitivity of transthoracic echocardiography in diagnosis of post-cardiac surgery tamponade

Amaç: Bu çalışmada transtorasik ekokardiyografinin (TTE) kalp cerrahisi sonrası gelişen kardiyak tamponad tanısındaki tanısal özgüllüğü ve duyarlılığı değerlendirildi.Çalışma planı: Ocak 2010 ve Eylül 2012 arasında açık kalp cerrahisi yapılan 2300 hastadan kanama veya kardiyak tamponad nedeniyle revizyon cerrahisi gereken 118'i (39 erkek, 79 kadın; ort. yaş 55.4±15.2 yıl; dağılım 19-80 yıl) retrospektif olarak değerlendirildi. Yetmiş üç hastanın TTE verileri mevcuttu. Transtorasik ekokardiyografinin ve hipotansiyon, oligüri ve metabolik asidoz gibi klinik parametrelerin tanısal özgüllüğü ve duyarlılığı cerrahi doğrulama esas alınarak hesaplandı. Özgüllük ve duyarlılık oranları Cochrane Q testi ve McNemar test kullanılarak karşılaştırıldı.Bul gu lar: İlk ameliyat sonrası geçen sürenin ortalama ve medyan değerleri sırasıyla 12.0±11.7 ve dokuz gün (0-62 gün) idi. Genel mortalite 28 hastada (%38.4) görüldü. Cerrahi olarak kanıtlanmış tamponad hastalarında, TTE %64.5 duyarlılığa sahip iken %92.0'sinde hipotansiyon, %80.6'sında oligüri ve %45.1'inde metabolik asidoz mevcuttu (p< 0.001). Cerrahi olarak tamponad olmadığı doğrulanmış hastalarda, TTE %90.9 özgüllüğe sahip iken, %54.5'inde hipotansiyon, %81.8'inde oligüri ve %45.4'ünde metabolik asidoz mevcuttu (p=0.07). Özgüllük oranları geçen zamanla sabitken duyarlılık oranları yedi günden sonra artma eğilimindeydi.So nuç: Transtorasik ekokardiyografi ameliyat sonrası hemodinamik bozulmanın değerlendirilmesinde önemli bir role sahiptir. Ancak, testin kardiyak tamponad tanısındaki yüksek yanlış negatiflik oranı, yüksek klinik şüphe varlığında zaman kaybının önlenmesi için akılda tutulmalıdır

Kalp cerrahisi sonrası kardiyak tamponad tanısında transtorasik ekokardiyografinin tanısal duyarlılığının değerlendirilmesi

Background: This study aims to evaluate the diagnostic specificity and sensitivity of transthoracic echocardiography (TTE) for the diagnosis of cardiac tamponade after cardiac surgery. Methods: Of 2,300 patients who underwent open heart surgery between January 2010 and September 2012, 118 (39 males, 79 females; mean age: 55.4±15.2 years; range 19 to 80 years) who required a revision surgery for bleeding and/or cardiac tamponade were retrospectively analyzed. Data of TTE were available in 73 patients. Diagnostic specificity and sensitivity of the TTE and clinical parameters including hypotension, oliguria, and metabolic acidosis were estimated with respect to surgical confirmation. Sensitivity and specifity rates were compared using the Cochrane Q test and McNemar test. Results: The mean and median time from the first operation were 12.0±11.7 and nine days, respectively (0 to 62 days). Overall mortality occurred in 28 patients (38.4%). Among patients with surgically confirmed tamponade, TTE showed 64.5% sensitivity, whereas hypotension was present in 92.0%, oliguria in 80.6% and metabolic acidosis in 45.1% (p< 0.001). Among patients with unconfirmed tamponade, TTE showed 90.9% specificity, whereas hypotension was present in 54.5% patients, oliguria in 81.8% and metabolic acidosis in 45.4% (p=0.07). Specificity rates showed constancy with time, while sensitivity rates tended to increase after seven days. Conclusion: Transthoracic echocardiography plays an important role in the evaluation of postoperative hemodynamic impairment. However, its high false negativity rate for diagnosis of cardiac tamponade should be kept in mind to prevent further delay in patients with high clinical suspicion

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