Left Ventricular Longitudinal Strain for Perioperative Cardiac Monitoring in Aortic Aneurysm Surgery Using Transthoracic 2-Dimensional Echocardiography: A Feasibility and Repeatability Study

Abstract

This study investigated perioperative echocardiographic image quality, the feasibility, and intra- and interobserver repeatability of left ventricular longitudinal two-dimensional strain echocardiography (2DSE) in aortic aneurysm surgery. A prospective, descriptive method evaluation. A single-center study. Eighteen patients undergoing elective open infrarenal aortic aneurysm repair. No intervention was made. Four echocardiographic examinations were made: E1, preoperatively; E2, within 4 hours after surgery; E3, the first postoperative day; and E4, the second postoperative day. Four-chamber, 2-chamber, and longitudinal axis apical views were achieved. Image quality was scored visually on a scale from 1 to 5 with 5 as the best, and the 2-dimensional strain echocardiography (2DSE) software was applied to measure peak systolic strain. Blinded analyses were performed twice by 1 observer and once by a second observer. Image quality decreased significantly after surgery as compared with the preoperative examination, but 72% of patients had at least 1 image scoring >/=3 through all examinations. The software was able to measure the segmental and global left ventricular peak systolic strain in 80% and 61%, respectively, for the first observer and 71% and 26%, respectively, for the second observer. The coefficients of repeatability for intra- and interobserver measurements were 5.5% and 7.3% for segmental strain and 1.6% and 3.5% for global strain. 2DSE was more feasible and repeatable when echocardiographic images were good. Feasibility and repeatability of 2DSE is good but affected by image quality. This study shows that 2DSE can be used in a clinical setting.