Perioperative course of two-dimensional left ventricular global longitudinal strain in coronary artery bypass surgery

Abstract

IntroductionThere are only few data on perioperative left ventricular strain analysis and perioperative normal values are lacking. We aimed to delineate the normal perioperative course of two-dimensional left ventricular global longitudinal strain in coronary artery bypass surgery patients.Methods40 adult patients scheduled for elective isolated on pump CABG with preoperative preserved left and right ventricular function and preoperative sinus rhythm were included.Transthoracic echocardiography (TTE) was performed the day before surgery (t1) and before discharge from hospital (t4). Intraoperatively, we performed transesophageal echocardiography (TEE) after induction of anesthesia (t2) and after sternotomy (t3). All measurements were done under hemodynamic stable conditions with Philips Epic 7 echocardiography machines. Patients were restricted to infusion until intraoperative echocardiography. No inotropic or vasopressor agent was given before or during echocardiographic assessment and patients were not pacer-dependent at any time of echocardiographic evaluation. Settings of the ultrasound machine were adapted to high temporal resolution with frame rate of 40 - 80 Hz as recommended1, 2.ResultsThere were no significant differences between preoperative and intraoperative assessment for left ventricular ejection fraction and for global longitudinal strain (57,95+7,54% vs. 57,55+7,37% and -15,53+3,87 vs. -16,41+3,91, both not significant). There was no significant change in the perioperative interval (t1 vs. t4) of left ventricular ejection fraction and tissue velocity of lateral mitral annulus, however global longitudinal strain deteriorated postoperative significantly (-15,53+3,87 vs -12,61+4,03, p<0,001).DiscussionTherefore 2D-LV-GLS might be a more sensitive parameters for detection of perioperative LV dysfunction than conventional two-dimensional echocardiographic measurements. There are only few data on perioperative left ventricular strain analysis and perioperative normal values are lacking. We aimed to delineate the normal perioperative course of two-dimensional left ventricular global longitudinal strain in coronary artery bypass surgery patients. 40 adult patients scheduled for elective isolated on pump CABG with preoperative preserved left and right ventricular function and preoperative sinus rhythm were included. Transthoracic echocardiography (TTE) was performed the day before surgery (t1) and before discharge from hospital (t4). Intraoperatively, we performed transesophageal echocardiography (TEE) after induction of anesthesia (t2) and after sternotomy (t3). All measurements were done under hemodynamic stable conditions with Philips Epic 7 echocardiography machines. Patients were restricted to infusion until intraoperative echocardiography. No inotropic or vasopressor agent was given before or during echocardiographic assessment and patients were not pacer-dependent at any time of echocardiographic evaluation. Settings of the ultrasound machine were adapted to high temporal resolution with frame rate of 40 - 80 Hz as recommended1, 2. There were no significant differences between preoperative and intraoperative assessment for left ventricular ejection fraction and for global longitudinal strain (57,95+7,54% vs. 57,55+7,37% and -15,53+3,87 vs. -16,41+3,91, both not significant). There was no significant change in the perioperative interval (t1 vs. t4) of left ventricular ejection fraction and tissue velocity of lateral mitral annulus, however global longitudinal strain deteriorated postoperative significantly (-15,53+3,87 vs -12,61+4,03, p<0,001). Therefore 2D-LV-GLS might be a more sensitive parameters for detection of perioperative LV dysfunction than conventional two-dimensional echocardiographic measurements.