To evaluate the incremental prognostic value of longitudinal strain over left ventricular ejection fraction (LVEF) after coronary artery bypass grafting (CABG).
Retrospective cohort study.
Single tertiary-care center.
Patients underwent isolated CABG between January 2014 and December 2019.
Measurements and Main Results
There were 999 patients (median age, 65 years, 23.5% female) categorized into 3 groups according to their left ventricular (LV) systolic function status: pEF/pS (preserved LVEF and preserved longitudinal strain, n = 490), pEF/iS (preserved LVEF and impaired longitudinal strain, n = 186), and rEF (reduced LVEF, n = 323). During a median follow-up of 2.7 years, 86 (8.6%) patients had died. The 5-year survival significantly differed in patients with preserved LVEF according to the strain status (pEF/pS v pEF/iS, 90.0% v 84.6%; p = 0.002). After adjusting for potential confounders, the pEF/iS group (adjusted hazard ratio [HR], 2.17; 95% CI, 1.10-4.28; p = 0.03) and the rEF group (adjusted HR, 2.96; 95% CI, 1.46-6.00; p = 0.003) had significantly higher risks for all-cause death compared with the pEF/pS group. The addition of longitudinal strain to LVEF in the prediction model significantly improved its performance (global chi-squared, 105.2 v 110.2; p = 0.03).
Left ventricular longitudinal strain could differentiate the prognosis after CABG in patients with preserved LVEF and provide significant incremental prognostic value to LVEF.
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Published online: August 19, 2022
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- Prognosticating with Left Ventricular Global Longitudinal Strain – A New Opportunity for Cardiac AnesthesiologistsJournal of Cardiothoracic and Vascular Anesthesia
- PreviewLeft ventricular (LV) ejection fraction lacks sensitivity for identifying subclinical LV impairment from subendocardial longitudinal fiber disease, which may not affect LV ejection fraction measurements.1 LV strain is an echocardiographic measure of myocardial function capable of quantifying longitudinal, radial, and circumferential contractions.2 LV longitudinal strain is extensively used in the outpatient setting to predict outcomes in patients with valvular heart disease,3 cardiomyopathies,4 or undergoing anthracycline chemotherapy5 with a normal LV ejection fraction.