Regional Left Ventricular Myocardial Dysfunction After Cardiac Surgery Characterized by 3-Dimensional Strain

Area of Science:

• Cardiology
• Medical Imaging
• Cardiac Surgery

Background:

• Left ventricular (LV) function is crucial for predicting outcomes after cardiac surgery.
• Ejection fraction has limitations; three-dimensional (3D) strain offers more accurate characterization.
• Regional 3D strain patterns post-cardiac surgery are not well-defined.

Purpose of the Study:

• To define differential patterns of regional LV dysfunction using 3D speckle tracking strain imaging after cardiac surgery.
• To investigate the predictive value of regional strain changes for postoperative outcomes, including ICU stay and 1-year survival.

Main Methods:

• Prospective study of 182 patients undergoing various cardiac surgeries.
• Preoperative and early postoperative 3D transthoracic echocardiograms were performed.
• LV regional longitudinal, circumferential, radial, and area strain were analyzed using a 17-segment model.

Main Results:

• Regional 3D strain showed procedure-specific patterns of myocardial dysfunction.
• Mitral valve surgery patients exhibited widespread dysfunction; Aortic valve replacement patients showed apical dysfunction.
• Apical segments had greater dysfunction than basal segments; circumferential and area strain showed larger decrements than longitudinal strain.
• Preoperative regional strain and its change predicted 1-year event-free survival and ICU length of stay.

Conclusions:

• Postoperative regional myocardial function changes are heterogeneous, varying by surgical procedure and strain type.
• Differences in regional LV function pre- to post-surgery correlate with worse long-term outcomes.
• 3D regional strain can identify high-risk patients, enabling early interventions to mitigate adverse outcomes.