Key result
Preoperative LV-GLS independently predicted postoperative low cardiac output syndrome (p=0.040) and was associated with 30-day mortality (OR 1.3; 95% CI 1.02-1.69).
Why the study?
Low cardiac output syndrome after surgical aortic valve replacement is associated with increased mortality and costs, but risk stratification using echocardiographic strain parameters in patients without severely reduced LVEF is not well established.
Does preoperative LV-GLS and RVFWS predict postoperative low cardiac output syndrome in patients with severe aortic stenosis undergoing surgical aortic valve replacement?
Cohort (n=75)
Does preoperative LV-GLS and RVFWS predict postoperative low cardiac output syndrome in patients with severe aortic stenosis undergoing surgical aortic valve replacement?
Answers are grounded in this paper and cite their sources.
Preoperative LV-GLS and RVFWS are useful parameters for risk stratification and independently predict the occurrence of low cardiac output syndrome in patients undergoing surgical aortic valve replacement.
Low cardiac output syndrome (LCOS) after surgical aortic valve replacement (SAVR) is related to increased mortality and treatment related costs. We aimed to evaluate whether echocardiography-derived left ventricular global longitudinal strain (LV-GLS) relates to the occurrence of postoperative LCOS in patients undergoing SAVR. We prospectively enrolled 75 patients with symptomatic severe aortic stenosis, left ventricular ejection fraction (LVEF) >40%, NYHA Class <IV, without other significant valve disease. Echocardiographic examination, including LV-GLS assessment was performed before SAVR. In a subgroup of patients right ventricular free wall strain (RVFWS) was also measured. The main outcome was the occurrence of LCOS. Secondary outcome was 30-day mortality. Patients were divided according to LCOS occurrence, which was found in 41% of the population. Baseline clinical characteristics were similar between groups except for LVEF, and LV-GLS. We found LV-GLS to be related to 30-day mortality (OR 1.3, p < 0.041, 95% CI 1.02-1.69). After multivariate analysis for variables related to LCOS, only age (p = 0.034), LVEF (p = 0.037) and LV-GLS (p = 0.040) independently predicted LCOS. Mean RVFWS was lower in patients in whom the primary outcome occurred (-12.8 ± 4.3 vs. -17.1 ± 3.9, p = 0.0081). In ROC curves analysis a RVFWS of -15% yielded a sensitivity of 81.2% and specificity of 71.4% for the occurrence of LCOS. LV-GLS is a useful parameter for risk stratification in patients with severe aortic stenosis without severely depressed LVEF, and is independently associated with LCOS occurrence. RVFWS wall strain may be useful for risk stratification in patients undergoing AVR.
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Balderas-Muñoz et al. (2017) conducted a cohort in symptomatic severe aortic stenosis (n=75). Left ventricular global longitudinal strain (LV-GLS) was evaluated on occurrence of postoperative low cardiac output syndrome (LCOS) (p=0.040). Preoperative LV-GLS independently predicted postoperative low cardiac output syndrome (p=0.040) and was associated with 30-day mortality (OR 1.3; 95% CI 1.02-1.69).
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