Value of Three Dimensional Strain Imaging on Assessing Left Ventricular Systolic Function and Predicting Short-Term Outcome in Chronic Aortic Regurgitation Undergoing Valve Replacement Surgery

Abstract

This study aimed to evaluate the subtle left ventricular function change in chronic aortic regurgitation (AR) patients using three dimensional strain imaging (3D STI) and to investigate its perioperative prognostic value. 3D STI were analyzed in 30 controls, 31 chronic AR patients with preserved LV function (AR+PEF group, LVEF≥55%), and 36 patients with LV dysfunction (AR+REF group, LVEF<55%). Among them, 32 patients underwent aortic valve replacement surgery (AVR). (1) Comparing controls, global longitudinal strain (GLS, -19.93±1.82% vs. -17.87±2.43%), global radial strain (GRS, 43.63±3.28% vs. 39.80±4.51% ), and torsion (2.31±0.60°/cm vs. 1.65±0.41°/cm) were reduced in AR+PEF, with global circumferential strain (GCS, -32.47±3.53%vs. -20.74±4.82%), GLS (-19.93±1.82% vs. -12.56±2.62 %), GRS (43.63±3.28% vs. 27.13±5.90 %), and torsion (2.31±0.60 °/cm vs. 1.17±0.46°/cm) reduced in AR+REF. (2) Strains in middle segments (LS -18.44±3.34%vs. -15.21±3.50%, CS -37.03±5.51%vs-33.67±4.09%, RS 46.02±5.82% vs. 40.22±4.34%, respectively), in apical segments (LS -21.73±5.27 % vs. -19.18±7.85%, CS -39.07±5.32 %vs. -35.08±4.64 %, RS 50.73±6.74 % vs. 45.20±9.24 %, respectively), and apical rotation (10.42±2.92°vs. 8.47±3.07°) were all reduced in AR+PEF, with basal segmental strains and rotation preserved. (3) Preoperative GLS was the unique independent predictor of perioperative cardiac adverse events. The receiver operating characteristic curves showed that optimal cut-off point was -15.65% with the area under the curve 0.765. 3D STI can detect subclinical left ventricular dysfunction in AR patients. For patients with preserved LVEF, GCS, basal strains and rotation were important in maintaining normal LEVF. GLS can predict perioperative cardiac adverse events in AVR.