Strain echocardiography for perioperative assessment of the left ventricle and left atrium in patients undergoing coronary artery bypass surgery

Objective. To evaluate the left ventricle (LV) and left atrium (LA)strain in early and mid-term postoperative period after CABG, and to analyze the effect on the risk of postoperative complications. Material and methods. The study included 84 patients with coronary artery disease who underwent CABG. The study cohort consisted of 82 (80%) men and 21 (20%) women aged 62.9±1.0 years. LV and LA strain and strain rate was analyzed before surgery, after 7 days and in mid-term (1 year) period after CABG. Humoral markers (CRP, TNF-α, IL-6, IL-8, Bcl-2, cytochrome C, SOD, troponin-I, MB-creatinephosphokinase) were estimated before surgery, 6 and 24 hours after CABG. Results. CABG is associated with significant early postoperative reduction in LV and LA strain. A year after surgery, these indicators returned to preoperative values and improved later. Reduced mechanical function of the left atrium, increased LA stiffness before surgery and in early postoperative period predict the risk of atrial fibrillation after CABG. The following preoperative factors associated with atrial fibrillation were established: LASr <9%, LAScd <7%, LA stiffness >0.7. Postoperative indicators associated with atrial fibrillation were established: LAScd <4%, LASct <4%, LASRr <0.4 s–1, LASRcd <0.4 s–1, LA stiffness >0.9. Conclusion. Strain-echocardiography is accurate diagnostic tool for assessing overall LV systolic function and LA mechanics. Strain-echocardiography can detect subclinical myocardial dysfunction and should be primary tool for preoperative and postoperative assessment of left ventricular and left atrium function in patients undergoing CABG.