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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 5, September/October 2017
AFRICA
313
acute trauma would tend to lower the absolute value of RV GLS.
A previous study revealed that RV GLS value
≥
–15.5% was
associated with adverse clinical events and death in patients
with inferior ST-segment elevation myocardial infarction
(STEMI).
28
The authors suggested that RV GLS was the major
predictor of long-term clinical outcome in patients with acute
inferior STEMI and preserved LVEF. Similarly, RV GLS value
>
–14.85% was associated with adverse clinical events in our
study patients with preserved LVEF who had compromised
pulmonary haemodynamics due to femur fracture.
It is notable from our analysis that the subclinical changes
in RV function identified as decreases in RV longitudinal strain
could be detected using two-dimensional strain analysis; these
findings provide additional information to predict pulmonary
complications in compromised pulmonary haemodynamics after
acute long-bone trauma. Likewise, RV strain may help to further
our understanding of pulmonary haemodynamic changes.
Limitations
Some limitations of this study should be considered. First, this
study was a retrospective observational study. Moreover, it was
a single-centre experience with a relatively small sample size.
Because quantitative analysis could have been affected by the
quality of stored images, we excluded patients with inadequate
echocardiographic image quality. Although a prospective study
with more patients and a longer postoperative observation
period may help identify additional factors, impaired RV GLS
in patients after the acute trauma of long-bone fracture was
significantly associated with more short-term clinical events and
may provide useful information to manage trauma patients in
real-world clinical situations.
Conclusions
In patients with femur fracture, the short-term pulmonary
complication rate was 10.3% and this was increased by worse
RV GLS values and longer hospital stays. Because of the
high incidence of pulmonary complications in femur fracture,
patients with RV GLS values
>
–14.85% should be monitored
closely before and after surgery to detect pulmonary events.
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