Key result
Impaired preoperative LVGLS linked to ~30% higher risk of 30-day postoperative CV events and MINS.
Why the study?
The usefulness of preoperative measurement of left ventricular global longitudinal strain for predicting prognosis in patients undergoing non-cardiac surgery had not been evaluated.
Does preoperative impaired LVGLS predict postoperative cardiovascular events and myocardial injury in patients undergoing major non-cardiac surgery?
Cohort (n=871)
Yes
Does preoperative impaired LVGLS predict postoperative cardiovascular events and myocardial injury in patients undergoing major non-cardiac surgery?
Answers are grounded in this paper and cite their sources.
Preoperative LVGLS provides independent and incremental prognostic value for predicting early postoperative cardiovascular events and myocardial injury in patients undergoing major non-cardiac surgery.
BACKGROUND: The usefulness of preoperative measurement of left ventricular global longitudinal strain (LVGLS) for predicting prognosis in patients undergoing non-cardiac surgery has not been evaluated. We analyzed the prognostic value of LVGLS in predicting postoperative 30-day cardiovascular events and myocardial injury after non-cardiac surgery (MINS). METHODS: This prospective cohort study was conducted in two referral hospitals and included 871 patients who underwent non-cardiac surgery <1 month after preoperative echocardiography. Those with ejection fraction <40%, valvular heart disease, and regional wall motion abnormality were excluded. The co-primary endpoints were the (1) composite incidence of all-cause death, acute coronary syndrome (ACS), and MINS and (2) composite incidence of all-cause death and ACS. RESULTS: Among the 871 participants enrolled (mean age: 72.9 years; female: 60.8%), there were 43 cases of the primary endpoint (4.9%): 10 deaths, 3 ACS, and 37 MINS. Participants with impaired LVGLS (≤16.6%) had a higher incidence of the co-primary endpoints (log-rank P < 0.001 and 0.015) than those without. The result was similar after adjustment with clinical variables and preoperative troponin T levels (hazard ratio = 1.30, 95% confidence interval [CI] = 1.03-1.65; P = 0.027). In sequential Cox analysis and net reclassification index, LVGLS had an incremental value for predicting the co-primary endpoints after non-cardiac surgery. Among the 538 (61.8%) participants who underwent serial troponin assay, LVGLS predicted MINS independently from the traditional risk factors (odds ratio = 3.54, 95% CI = 1.70-7.36; P = 0.001). CONCLUSIONS: Preoperative LVGLS has an independent and incremental prognostic value in predicting early postoperative cardiovascular events and MINS. CLINICAL TRIAL REGISTRATION: URL: https://trialsearch.who.int/. Unique identifiers: KCT0005147.
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Kim et al. (2023) conducted a cohort in major non-cardiac surgery (n=871). Impaired preoperative left ventricular global longitudinal strain (LVGLS ≤16.6%) vs. Normal LVGLS (>16.6%) was evaluated on Composite incidence of all-cause death, acute coronary syndrome (ACS), and MINS, and composite incidence of all-cause death and ACS (HR 1.30, 95% CI 1.03-1.65, p=0.027). Impaired preoperative left ventricular global longitudinal strain (≤16.6%) was associated with a higher risk of 30-day postoperative cardiovascular events and MINS (HR 1.30; 95% CI 1.03-1.65; P=0.027).
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