Highlights
- •2D-LV GLS did not differ significantly in awake versus anesthetized patients.
- •2D-LV GLS did not decline after sternotomy.
- •2D-LV GLS deteriorated after uneventful, complication-free on-pump CABG.
- •Whereas LV EF and LV S´ remained unchanged.
Objectives
There are limited data on perioperative left ventricular strain. The authors aimed
to describe the entire perioperative course of two-dimensional left ventricular global
longitudinal strain in patients undergoing coronary artery bypass graft (CABG) surgery
and compare to common parameters of LV function assessment.
Design
Prospective observational study.
Setting
Single university hospital.
Participants
Forty patients scheduled for isolated on-pump CABG surgery with preserved left and
right ventricular function with an unremarkable, complication-free perioperative course.
Interventions
Two-dimensional strain analysis and standard echocardiographic assessment of left
ventricular function were performed pre- (T1) and postoperatively (T4) by transthoracic
echocardiography (TTE) and intraoperatively pre- (T2) and poststernotomy (T3) by transesophageal
echocardiography (TEE). Echocardiography was performed under stable hemodynamics and
predefined fluid management, in sinus rhythm without any vasoactive support.
Measurements and Main Results
Analysis of two-dimensional LV global longitudinal strain (2D-LV GLS) was performed
using Tomtec 2D Cardiac Performance Analysis software. Philips QLAB 10.8 was used
to analyze left ventricular ejection fraction (LV EF) and tissue velocity of the lateral
mitral annulus (LV S ́). There were no significant differences (median with interquartile
range [IQR]) after induction of anesthesia in values of LV EF and 2D-LV GLS (T1 v T2; 59% [IQR, 52 to 64] v 56% [IQR, 51.75 to 63] and -15.2 [IQR, –18.05 to –13.08] v –15.6 [IQR, –17.65 to –13.88]; both not significant [ns]), while LV S´ declined (T1
v T2, 7 cm/s [IQR, 5.25 to 8] v 5.25 cm/s [IQR, 4.6 to 6.83]; p < 0.001). Bland-Altman analysis for this comparison
of 2D-LV GLS (T1 v T2) showed that bias was not significant between both techniques; however, there
were limits of agreement. After sternotomy (T2 v T3) neither LV EF nor 2D-LV GLS or LV S´ declined. 2D-LV GLS deteriorated significantly
after CABG (T1 v T4; –15.2 [IQR, –18.05 to –13.08] v –11.3 [IQR, –15.8 to –9.78]; p < 0.001). In contrast, LV EF and LV S´ did not change
significantly in the perioperative interval (T1 v T4; 59% [IQR, 52 to 64] v 56% [IQR, 51.5 to 64.25] and 7 cm/s [IQR, 5.25 to 8] v 7 cm/s [IQR, 6 to 8]; both ns).
Conclusion
Values of 2D-LV GLS did not differ in awake, spontaneously breathing patients assessed
by TTE and in anesthetized and ventilated patients with stable hemodynamics measured
by TEE. 2D-LV GLS did not change after sternotomy; however, it declined significantly
after on-pump CABG, while LV EF and LV S´ remained unchanged.
Key Words
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Article info
Publication history
Published online: August 24, 2021
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- Global Left Ventricular Strain: Exciting Applications In Perioperative PracticeJournal of Cardiothoracic and Vascular AnesthesiaVol. 36Issue 1
- PreviewPerioperative assessment of ventricular function by echocardiography is common in the contemporary practice of cardiac anesthesiology.1 Although left ventricular ejection fraction is a gold standard for evaluating left ventricular function, it has shortcomings, including observer variability, load dependency, and a lack of sensitivity for the detection of early ventricular dysfunction.1-3 Newer echocardiographic modalities, such as strain analysis, can be effective in measuring systolic function for cardiac surgical patients, but still require further validation and broader implementation in the operating room setting.
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