Incremental Prognostic Value of Left Ventricular Longitudinal Strain Over Ejection Fraction in Coronary Artery Bypass...

Area of Science:

• Cardiology
• Cardiac Surgery
• Echocardiography

Background:

• Left ventricular ejection fraction (LVEF) is a standard measure of systolic function but may not fully capture myocardial performance.
• Assessing longitudinal strain offers a more sensitive evaluation of left ventricular function.
• Coronary artery bypass grafting (CABG) outcomes can be influenced by pre-operative cardiac function.

Purpose of the Study:

• To determine if longitudinal strain provides additional prognostic value compared to LVEF in patients undergoing CABG.
• To assess the association between longitudinal strain and all-cause mortality after CABG.
• To evaluate the incremental predictive capability of longitudinal strain in risk stratification models.

Main Methods:

• Retrospective cohort study of 999 patients undergoing isolated CABG.
• Patients were categorized by preserved or reduced LVEF and preserved or impaired longitudinal strain.
• Survival analysis was performed, adjusting for potential confounders.

Main Results:

• Patients with preserved LVEF but impaired longitudinal strain had significantly higher mortality risk (aHR 2.17) compared to those with preserved LVEF and strain.
• Reduced LVEF also conferred a significantly higher mortality risk (aHR 2.96).
• Incorporating longitudinal strain into prediction models significantly improved their performance.

Conclusions:

• Left ventricular longitudinal strain is a valuable independent predictor of prognosis after CABG.
• Longitudinal strain offers incremental prognostic value over LVEF, particularly in patients with preserved LVEF.
• This metric can enhance risk stratification and guide clinical decision-making in post-CABG patients.