Key result
Lower pre-operative LV global work index is linked to post-operative LV dysfunction in severe AR.
Why the study?
The association of non-invasive myocardial work indices with post-operative left ventricular dysfunction in chronic severe aortic regurgitation patients was not established.
Do pre-operative non-invasive myocardial work indices predict post-operative LV dysfunction in patients with chronic severe aortic regurgitation and preserved LVEF undergoing aortic valve surgery?
Observational (n=141)
Do pre-operative non-invasive myocardial work indices predict post-operative LV dysfunction in patients with chronic severe aortic regurgitation and preserved LVEF undergoing aortic valve surgery?
Odds Ratio: 0.99 (95% CI 0.98–1)
p-value: p=<0.001
Pre-operative non-invasive myocardial work indices, specifically LV GWI and LV GCW, are associated with post-operative LV dysfunction in patients with severe aortic regurgitation and preserved LVEF, offering potential value for surgical risk stratification.
Impaired pre-operative myocardial work indices associate with post-operative LV dysfunction in severe AR; leaves open added value for risk stratification beyond LVEF.
AIMS: Non-invasive myocardial work offers a promising echocardiographic method to evaluate left ventricular (LV) function as it integrates myocardial deformation and afterload. The study sought to investigate the association of myocardial work indices with post-operative LV dysfunction in patients with chronic severe aortic regurgitation (AR). METHODS AND RESULTS: Pre-operative LV ejection fraction (LVEF), LV global work index (LV GWI), LV global constructive work (LV GCW), LV global wasted work (LV GWW), and LV global work efficiency (LV GWE) were measured. Post-operative LV dysfunction was defined as LVEF < 50% at 12 months after surgery. One hundred and forty-one patients with chronic severe AR and preserved LVEF (52 (42-58) years; 74.5% men) who underwent aortic valve surgery were studied. Twenty-six patients (18%) developed post-operative LV dysfunction. Patients with post-operative LV dysfunction had lower LV GWI, LV GCW, and LV GWE compared with those without (all P < 0.05). In multivariate analysis, LV GWI (adjusted odds ratio (OR): 0.99; 95% CI: 0.98-1.00; P < 0.001), and LV GCW (adjusted OR: 0.99; 95% CI: 0.99-1.00; P < 0.001) were associated with post-operative LV dysfunction. Moreover, a multivariate logistic regression model with LV GWI (Akaike information criterion = 108.023, Bayesian information criterion = 119.818, C-statistics = 0.836) showed the best capability in predicting post-operative LV dysfunction. The comparative analysis of C-statistics across the three models-LV GWI, LV GCW, and LV GLS-did not reveal statistically significant differences (all P > 0.05). CONCLUSION: In patients with chronic severe AR and preserved LVEF, impaired myocardial work indices are associated with post-operative LV dysfunction. Myocardial work has potential value for risk stratification and surgical decision-making in such a population.
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Wang et al. (2024) conducted an observational in Chronic severe aortic regurgitation with preserved LVEF (n=141). Pre-operative myocardial work indices (LV GWI, LV GCW) was evaluated on Post-operative LV dysfunction (LVEF < 50% at 12 months after surgery) (adjusted OR 0.99, 95% CI 0.98-1.00, p=<0.001). Pre-operative left ventricular global work index was significantly associated with post-operative LV dysfunction in patients with severe aortic regurgitation (adjusted OR 0.99; 95% CI 0.98-1.00; P<0.001).
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