Predictors and outcomes of early left ventricular dysfunction in paediatric patients postoperative for ventricular septal defect: a retrospective cohort study based on myocardial strain and work

Q: What are the key findings of this study?

Decreased preoperative left ventricular global work efficiency independently predicted early postoperative LV dysfunction (OR 0.87) and correlated with persistent symptoms at 12-month follow-up.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Ventricular septal defect (VSD) (n=409). Intervention: Preoperative left ventricular global work efficiency (LV GWE) vs. Higher preoperative LV GWE. Primary outcome: Early postoperative left ventricular dysfunction (LVEF < 55% during hospitalisation) (OR 0.87, 95% CI 0.80-0.95, p=0.002).

Q: What does this research mean for the field?

Preoperative left ventricular myocardial work and strain indices independently predict early postoperative left ventricular dysfunction and correlate with impaired 12-month functional recovery following pediatric ventricular septal defect repair. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Lang Gao; Jinnan Zhang; Qiuzhe Guo; Lulu Zhang; Xiaoli Dong; Jingjin Wang; Zhiling Luo

doi:10.1186/s12887-026-07470-6

August 1, 2026BMC PediatricsOpen Access

Predictors and outcomes of early left ventricular dysfunction in paediatric patients postoperative for ventricular septal defect: a retrospective cohort study based on myocardial strain and work

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Key result

Higher preoperative LV global work efficiency linked to ~13% lower odds of postoperative dysfunction.

OR 0.87
95% CI 0.80-0.95
P=0.002
n=409

Why the study?

Early postoperative LV dysfunction frequently occurs after VSD repair in paediatric patients, but its risk factors and impact on follow-up cardiac function remain unclear.

Do preoperative myocardial strain and work indices predict early postoperative left ventricular dysfunction in pediatric patients undergoing surgical ventricular septal defect repair?

Key Points

Investigate preoperative predictors of early postoperative left ventricular dysfunction using myocardial strain and work, and evaluate its impact on 12-month cardiac functional recovery after paediatric ventricular septal defect repair.
Retrospectively analyzed 409 paediatric patients (median age 3.00 [1.00–5.75] years; 50.4% male) with preserved preoperative LVEF (≥ 55%) undergoing isolated surgical VSD repair.
Assessed preoperative echocardiographic parameters including myocardial strain and work, defining early postoperative LV dysfunction as LVEF < 55% during hospitalisation.
Evaluated functional status recovery at 1, 3, 6, and 12 months post-discharge using Ross Classifications.
Postoperative LV dysfunction occurred in 82 (20.05%) patients during hospitalisation.
Multivariate logistic regression revealed preoperative LV GLS (OR: 1.15; 95% CI: 1.02–1.29; p = 0.017), LV GWI (OR: 0.86; 95% CI: 0.76–0.97; p = 0.017), and LV GWE (OR: 0.87; 95% CI: 0.80–0.95; p = 0.002) were independently associated with postoperative LV dysfunction, with integrated clinical models yielding AUCs of 0.848–0.883 (p < 0.001).
Patients with postoperative LV dysfunction exhibited significantly less favourable Ross classification recovery outcomes at 12 months after surgery (p = 0.005).

Study Design

Type

Cohort (n=409)

Multicenter

No

Structured PICO

Do preoperative myocardial strain and work indices predict early postoperative left ventricular dysfunction in pediatric patients undergoing surgical ventricular septal defect repair?

P

Population

409 pediatric patients (aged 0-14 years) with ventricular septal defect and preserved baseline LVEF undergoing isolated surgical repair, followed for up to 12 months.

E

Exposure

Isolated surgical ventricular septal defect (VSD) repair using cardiopulmonary bypass (CPB) and preoperative transthoracic echocardiography to assess myocardial strain and work indices.

O

Outcome

Early postoperative left ventricular (LV) dysfunction, defined as LV ejection fraction (LVEF) < 55% during the postoperative hospitalization period.surrogate

Main Result

Odds Ratio: 0.87 (95% CI 0.8–0.95)

p-value: p=0.002

Limitations

Single-centre retrospective design may limit the generalisability of the findings.
Non-invasive cuff-based arterial blood pressure measurements used in myocardial work estimation may not precisely represent true LV pressure.
Long-term follow-up data beyond 12 months are needed to assess the lifetime impact of postoperative LV dysfunction.
Single-centre retrospective design which may limit generalisability
Non-invasive cuff-based arterial blood pressure measurements used in myocardial work estimation may not precisely represent LV pressure
Lack of long-term follow-up data to assess the lifetime impact of early postoperative LV dysfunction

Implication

Preoperative assessment of myocardial strain and work provides high predictive value for early postoperative left ventricular dysfunction after pediatric VSD repair, which is associated with persistent symptoms at 12 months.

Abstract

Background Early postoperative left ventricular (LV) dysfunction commonly occurs after ventricular septal defect (VSD) repair in paediatric patients. This study aimed to investigate its risk factors and impact on follow-up cardiac functional status. Methods We retrospectively enrolled patients with preserved LV ejection fraction (LVEF) (≥ 55%) undergoing isolated surgical VSD repair. Early postoperative LV dysfunction was defined as LVEF < 55% during hospitalisation. LV function parameters including myocardial strain and work were obtained. Cardiac functional recovery was assessed at 1, 3, 6, and 12 months post-discharge based on Ross Classifications. Results The cohort comprised 409 patients (3.00 [1.00–5.75] years; 50.4% male), with 82 (20.05%) developing postoperative LV dysfunction. Multivariate analysis showed preoperative LV global longitudinal strain (LV GLS), global work index (LV GWI) and global work efficiency (LV GWE), LV end-diastolic volume index(LVEDVi), moderate-to-severe systolic pulmonary arterial pressure(sPAP), large VSD size and prolonged cardiopulmonary bypass(CPB) time were significantly associated with postoperative LV dysfunction (all p < 0.05). ROC analyses found that integrating LV GWI and GWE with clinical parameters (LVEDVi, VSD size, or sPAP) enhanced prediction (AUC 0.848–0.883, p < 0.001). During follow-up, patients with postoperative LV dysfunction exhibited less favourable Ross classification recovery at 12 months after surgery. Conclusions In VSD patients with preserved LVEF, impaired preoperative myocardial strain and work indices predict early postoperative LV dysfunction, which correlates with persistent symptoms and cardiac dysfunction at 12-month follow-up. Integrated pre- and postoperative assessment using these novel parameters may optimise the management of this patient population.

Discussion

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Cite This Study

Gao et al. (2026) conducted a cohort in Ventricular septal defect (VSD) (n=409). Preoperative left ventricular global work efficiency (LV GWE) vs. Higher preoperative LV GWE was evaluated on Early postoperative left ventricular dysfunction (LVEF < 55% during hospitalisation) (OR 0.87, 95% CI 0.80-0.95, p=0.002). Decreased preoperative left ventricular global work efficiency independently predicted early postoperative LV dysfunction (OR 0.87) and correlated with persistent symptoms at 12-month follow-up.

synapsesocial.com/papers/6ad1155900741cc3fba7d331 https://doi.org/10.1186/s12887-026-07470-6

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Predictors and outcomes of early left ventricular dysfunction in paediatric patients postoperative for ventricular septal defect: a retrospective cohort study based on myocardial strain and work

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Predictors and outcomes of early left ventricular dysfunction in paediatric patients postoperative for ventricular septal defect: a retrospective cohort study based on myocardial strain and work

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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