Aortic valve replacement significantly improved LV diastolic strain as measured by SR-IVR (0.4 vs 0.31 s-1; P=0.01), whereas conventional echocardiographic measurements did not detect these changes.
Observational (n=30)
Does aortic valve replacement improve intraoperative left ventricular diastolic strain in adult patients with severe aortic valve stenosis?
Intraoperative assessment of LV diastolic strain is feasible during AVR and detects early improvements in LV relaxation and filling that conventional echocardiographic grading algorithms miss.
Absolute Event Rate: 0.4% vs 0.31%
p-value: p=0.01
PURPOSE: Assessment of LV diastolic dysfunction (LVDD) poses challenges due to the dynamic changes of loading conditions in the perioperative course. Diastolic strain-based measures showed to be less load dependent, but data in aortic valve replacement (AVR) surgery remains sparse to date. Therefore, we aimed to explore the feasibility to assess these measurements and to describe the intraoperative course in this patient population. METHODS: Prospective observational study including 30 adult patients. Intraoperative transesophageal echocardiography (TEE) was performed after induction of anesthesia T1, after termination of cardiopulmonary bypass T2, and after sternal closure T3. TEE assessment included the evaluation of peak longitudinal strain rate during isovolumetric relaxation (SR-IVR), early (SR-E) and late (SR-A) LV filling, as well as of conventional echocardiographic measurements and LVDD grading algorithms. RESULTS: Diastolic strain analysis was feasible in 27 (90%) AVR patients at all time points of assessment. LV diastolic strain improved significantly after AVR T1 vs T3 as measured by SR-IVR (0.31 s-1 (IQR 0.22; 0.38) vs. 0.4 s-1 (IQR 0.33; 0.43); P = 0.01), SR-E (1.13 s-1 (IQR 0.89;1.28) vs. 1.35 s-1 (IQR 1.10;1.52); P = 0.035), and E/SR-IVR (2.2 m (IQR 1.7;2.8) vs. 1.6 m (IQR 1.3;2.2); P = 0.013). In contrast, conventional echocardiographic measurements and grading algorithms were not able to detect these changes in the same period. CONCLUSION: Assessment of LV diastolic strain was feasible in our group of selected AVR patients. LV relaxation and filling improved during the intraoperative course of AVR as measured by diastolic strain, while most conventional grading algorithms were not able to detect these alterations.
Seuthe et al. (Tue,) conducted a observational in Severe Aortic Valve Stenosis (n=30). Aortic valve replacement (AVR) vs. Pre-AVR baseline (T1) was evaluated on Peak longitudinal strain rate during isovolumetric relaxation (SR-IVR) (p=0.01). Aortic valve replacement significantly improved LV diastolic strain as measured by SR-IVR (0.4 vs 0.31 s-1; P=0.01), whereas conventional echocardiographic measurements did not detect these changes.