Key result
On-pump cardiac surgery reduced global peak longitudinal strain from -14.5% preoperatively to -9.98% on postoperative day 1, remaining depressed for at least 30 days.
Why the study?
Does on-pump cardiac surgery reduce global peak longitudinal strain in patients undergoing CABG or AVR?
Observational (n=39)
Does on-pump cardiac surgery reduce global peak longitudinal strain in patients undergoing CABG or AVR?
Absolute Event Rate: -9.98% vs -14.5%
Global peak longitudinal strain remains depressed for at least 30 days following on-pump cardiac surgery before recovering by 6 months, and this dysfunction is not correlated with postoperative troponin T release.
May indicate prolonged subclinical dysfunction after on-pump surgery independent of troponin; hypothesis-generating and should not yet change practice.
OBJECTIVES: The myocardial recovery time following on-pump cardiac surgery remains uncertain. Global peak longitudinal strain is a sensitive measure of endocardial function which is most susceptible to ischaemia. We aimed to evaluate changes in global peak longitudinal strain up to 6 months after surgery and to compare initial changes with alterations in troponin T. Secondarily, we aimed to describe perioperative changes in strain of the inter-ventricular septum when compared with reference segments. METHODS: Patients scheduled for coronary bypass, aortic valve replacement or combination procedures were enrolled. Echocardiography was performed on the day before surgery, the day after surgery, 4 days after surgery, 30 days after surgery and 6 months after surgery. Troponin T was measured 3, 16 and 24 h following procedure. RESULTS: Forty patients were enrolled and one was later excluded. Global peak longitudinal strain decreased from -14.5 ± 3.33% preoperatively to -9.98 ± 3.09% and -10.57 ± 3.16% on the first and fourth postoperative day, respectively. Global strain was still reduced on the 30th postoperative day, but had returned to preoperative values 6 months after surgery. Absolute values and relative changes in global strain did not correlate with postoperative peak troponin T measurements. Strain of the inter-ventricular septum was unaffected by surgery as opposed to reference segments, although septal displacement in the longitudinal direction decreased from 12.0 ± 3.75 mm preoperatively to 3.58 ± 4.22 mm 4 days after surgery. CONCLUSIONS: Global peak longitudinal strain was reduced for at least 30 days after on-pump cardiac surgery and seems to represent a more sensitive marker of myocardial function than ejection fraction. The decrease in global strain was not reflected in troponin T measurements. The visual, echocardiographic impression of septal dysfunction may be a translational phenomenon, as septal strain was unaffected by surgery.
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Juhl‐Olsen et al. (2012) conducted an observational in On-pump cardiac surgery (n=39). On-pump cardiac surgery vs. Preoperative baseline was evaluated on Changes in global peak longitudinal strain. On-pump cardiac surgery reduced global peak longitudinal strain from -14.5% preoperatively to -9.98% on postoperative day 1, remaining depressed for at least 30 days.
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