Author + information
- Anne-Julie Boilard,
- Louis Simard,
- Lionel Tastet,
- Nancy Côté,
- Francois Dagenais and
- Marie-Annick Clavel
Background: Left ventricular (LV) ejection fraction (EF) remains the principal trigger for surgery indication in asymptomatic patients with aortic regurgitation (AR). However, even in patients with normal EF, early decrease in postoperative EF is correlated with worse outcome after surgery. We thus aimed to assess the interest of longitudinal strain (LS) and strain rate (LSR) to predict reduction of EF after the surgery, despite preserved preoperative EF in patients with AR.
Methods: Ninety seven patients with moderate-to-severe or severe AR and preserved preoperative EF who underwent an aortic surgery for pure AR were included in the study. We excluded patients with Marfan syndrome, previous or active endocarditis, aortic dissection, aneurysm and acute myocardial infarction less than 90 days before surgery. Trans-thoracic echocardiography was performed within 3 months before the surgery and one week after. LS and LSR were performed on apical 2, 3 and 4-chamber views. Due to missing images or inappropriate frame rate, LS and LSR were doable in 59 patients and calculated for septum, lateral wall (LW) and the entire LV.
Results: The mean age of our patients was 56 ± 14 years and 91% were men. Among our 97 patients, 31 (32%) had postoperative EF <50%. After adjustment for age, sex, LV systolic dimensions and severity of AR (i.e. background model), ILW-LSI <16% (p=0.02) or LW-LSR <0.90s-1 (p=0.006) were strongly associated with post-operative EF <50%. Pre-operative EF was not an independent predictor of postoperative EF <50% (p= 0.76). The addition of LW-LS or LW-LSR improved the background multivariate models (all p≤0.02).
Conclusions: In patients with preserved EF, operated for AR, the longitudinal strain and strain rate of the lateral wall were the best predictors of post-operative impaired EF. Those parameters might be useful tools to detect early LV systolic dysfunction and may be integrated in surgical decision making in asymptomatic patients with AR.
Moderated Poster Contributions
Valvular Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 11:15 a.m.-11:25 a.m.
Session Title: Novel Determinants of Outcomes in VHD
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1132M-13
- 2017 American College of Cardiology Foundation