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Evaluating the Use of Post-Systolic Shortening and Global Longitudinal Strain in Predicting Immediate Postoperative
Nanditha Sreedhar1, Guru Police Patel2, Anandathirtha Holavanahalli3
1Department of General Anesthesia (Cardiac Anesthesia), Ramaiah Medical College, Bangalore, Karnataka, India.
Objective:
To study the use of post-systolic shortening (PSS) and global longitudinal strain (GLS) in predicting immediate postoperative adverse events after coronary artery bypass grafting (CABG).
Design:
A prospective observational study.
Setting:
Conducted in a single tertiary care hospital.
Participants:
A total of 71 patients undergoing elective CABG were included in our study. Our patients were aged between 45 and 75 years and included both off-pump and on-pump cases. We excluded patients with left ventricular function less than 30%, severe diastolic dysfunction, severe right ventricular dysfunction, concomitant more than moderate valve dysfunction, arrhythmias, left or right bundle branch blocks, and unwillingness to participate in the study.
Methods:
Preoperative echocardiogram included left ventricular post-systolic index (LV PSI) and GLS. Postoperatively, composite adverse events were documented by measuring the vasoactive-inotrope score (VIS) of ≥ 10 at 24 h, total duration of inotropes >40 h, intensive care unit (ICU) stay >7 days, and adverse events like low cardiac output, acute kidney injury, ventilation requirement of >24 h, and any mortality.
Measurements And Main Results:
Left ventricular global longitudinal strain (LV GLS) and LV PSI values were analyzed using receiver operating characteristic (ROC) curves, and the area under the curve (AUC) was used to compare the prediction and to derive a cutoff. AUC for LV GLS and LV PSI was 0.92 each and showed good prediction. We got a cutoff of -14.6 for LV GLS and a cutoff of 10.5 for LV PSI.
Conclusion:
We conclude that GLS and PSI can effectively predict immediate postoperative adverse events effectively in patients undergoing CABG.
