COMPARISON OF GLOBAL LONGITUDINAL STRAIN WITH LEFT VENTRICULAR EJECTION FRACTION AS A PREDICTOR FOR IABP INSERTION IN PATIENTS UNDERGOING OFF-PUMP CORONARY ARTERY BYPASS GRAFTING: A PILOT STUDY

Abstract

<h3>Objective</h3> Prophylactic use of intra-aortic balloon pump (IABP) mainly depends on left ventricular (LV) systolic function. Global longitudinal strain (GLS) is the most studied parameter for LV strain. It has proved to be more sensitive than LV ejection fraction (EF) as a measure of LV systolic function and is a strong predictor of outcome. The primary aim was to determine whether GLS can be used as a reliable marker and its cut-off value for IABP insertion in patients undergoing elective off-pump coronary artery bypass grafting (OPCABG). The secondary aim was to correlate echocardiographic parameters with intensive care unit (ICU) parameters to predict early post-operative outcome. <h3>Design</h3> A prospective observational clinical study. <h3>Setting</h3> Single university hospital. <h3>Participants</h3> 100 adult patients scheduled for elective OPCABG. <h3>Intervention</h3> None <h3>Measurements and Main Results</h3> 2D speckle tracking echocardiography (STE) estimated GLS was computed and LV EF measured by 3D echocardiography. The study predicted that IABP insertion correlates better with GLS (post-revascularization > pre-revascularization) than with 3D LV EF. Receiver operating characteristics (ROC) curve analysis revealed highest area under the curve (AUC, 0.972) with cut-off value of > -9.8% for GLS with maximum combined sensitivity and specificity compared to 3D LV EF (AUC, 0.938) with cut-off value of ≤44%. ICU parameters show better correlation with E/e'> GLS > WMSI than 3D LV EF. <h3>Conclusion</h3> GLS is a better predictor of IABP insertion compared to 3D LV EF in patients undergoing OPCABG.