Balderas-Muñoz K, Rodríguez-Zanella H, Fritche-Salazar J F, Ávila-Vanzzini N, Juárez Orozco L E, Arias-Godínez J A, Calvillo-Argüelles O, Rivera-Peralta S, Sauza-Sosa J C, Ruiz-Esparza M E, Bucio-Reta E, Rómero A, Espinola-Zavaleta N, Domínguez-Mendez B, Gaxiola-Macias M, Martínez-Ríos M A
Cardiology Department, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico.
Echocardiography Laboratory, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico.
Int J Cardiovasc Imaging. 2017 Oct;33(10):1483-1489. doi: 10.1007/s10554-017-1139-6. Epub 2017 May 9.
Low cardiac output syndrome (LCOS) after surgical aortic valve replacement (SAVR) is related to increased mortality and treatment related costs. We aimed to evaluate whether echocardiography-derived left ventricular global longitudinal strain (LV-GLS) relates to the occurrence of postoperative LCOS in patients undergoing SAVR. We prospectively enrolled 75 patients with symptomatic severe aortic stenosis, left ventricular ejection fraction (LVEF) >40%, NYHA Class <IV, without other significant valve disease. Echocardiographic examination, including LV-GLS assessment was performed before SAVR. In a subgroup of patients right ventricular free wall strain (RVFWS) was also measured. The main outcome was the occurrence of LCOS. Secondary outcome was 30-day mortality. Patients were divided according to LCOS occurrence, which was found in 41% of the population. Baseline clinical characteristics were similar between groups except for LVEF, and LV-GLS. We found LV-GLS to be related to 30-day mortality (OR 1.3, p < 0.041, 95% CI 1.02-1.69). After multivariate analysis for variables related to LCOS, only age (p = 0.034), LVEF (p = 0.037) and LV-GLS (p = 0.040) independently predicted LCOS. Mean RVFWS was lower in patients in whom the primary outcome occurred (-12.8 ± 4.3 vs. -17.1 ± 3.9, p = 0.0081). In ROC curves analysis a RVFWS of -15% yielded a sensitivity of 81.2% and specificity of 71.4% for the occurrence of LCOS. LV-GLS is a useful parameter for risk stratification in patients with severe aortic stenosis without severely depressed LVEF, and is independently associated with LCOS occurrence. RVFWS wall strain may be useful for risk stratification in patients undergoing AVR.
外科主动脉瓣置换术（SAVR）后发生的低心排血量综合征（LCOS）与死亡率增加及治疗相关费用升高有关。我们旨在评估超声心动图得出的左心室整体纵向应变（LV-GLS）是否与接受SAVR患者术后LCOS的发生相关。我们前瞻性纳入了75例有症状的重度主动脉瓣狭窄患者，左心室射血分数（LVEF）>40%，纽约心脏协会（NYHA）心功能分级<IV级，且无其他显著瓣膜疾病。在SAVR前进行了包括LV-GLS评估在内的超声心动图检查。在一个亚组患者中还测量了右心室游离壁应变（RVFWS）。主要结局是LCOS的发生。次要结局是30天死亡率。根据LCOS的发生情况将患者分组，在41%的人群中发现了LCOS。除LVEF和LV-GLS外，各组间基线临床特征相似。我们发现LV-GLS与30天死亡率相关（比值比1.3，p<0.041，95%置信区间1.02-1.69）。在对与LCOS相关的变量进行多因素分析后，只有年龄（p=0.034）、LVEF（p=0.037）和LV-GLS（p=0.040）可独立预测LCOS。主要结局发生的患者平均RVFWS较低（-12.8±4.3对-17.1±3.9，p=0.0081）。在ROC曲线分析中，RVFWS为-15%时，LCOS发生的敏感性为81.2%，特异性为71.4%。对于无严重LVEF降低的重度主动脉瓣狭窄患者，LV-GLS是风险分层的有用参数，且与LCOS的发生独立相关。RVFWS壁应变可能对接受主动脉瓣置换术（AVR）的患者进行风险分层有用。
