Department of Anesthesiology and Pain Medicine, Laboratory for Perioperative Outcomes Analysis and Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2022 Oct;75(5):416-426. doi: 10.4097/kja.22201. Epub 2022 Jun 15.
Left ventricular longitudinal strain is an emerging marker of ventricular systolic function. However, the prognostic value of apical four-chamber longitudinal strain after heart valve surgery in real-world clinical practice is uncertain. The authors investigated whether left ventricular apical four-chamber longitudinal strain measured in real-world practice is helpful for predicting postoperative outcomes in patients undergoing heart valve surgery.
This observational cohort study was conducted in patients who underwent heart valve surgery between January 2014 and December 2018 at a tertiary hospital in South Korea. The exposure of interest was preoperative left ventricular apical four-chamber longitudinal strain. The primary outcome was postoperative all-cause mortality.
Among 1,773 study patients (median age, 63 years; female, 45.9%), 132 (7.4%) died during a median follow-up of 27.2 months. Preoperative left ventricular apical four-chamber longitudinal strain was significantly associated with all-cause mortality (adjusted hazard ratio, 0.94 per 1% increment in absolute value; 95% CI [0.90, 0.99], P = 0.022), whereas left ventricular ejection fraction (LVEF) was not significantly associated with all-cause mortality (adjusted hazard ratio: 1.01, 95% CI [0.99, 1.03], P = 0.222). Moreover, combining left ventricular apical four-chamber longitudinal strain to the LVEF and conventional prognostic factors enhance the prognostic model for all-cause mortality (P = 0.022).
In patients undergoing heart valve surgery without coronary artery disease, left ventricular apical four-chamber longitudinal strain measured in real-world clinical practice was independently associated with postoperative survival. Left ventricular longitudinal strain measurement may be helpful for outcome prediction after valve surgery.
左心室纵向应变是心室收缩功能的新兴标志物。然而，在真实临床实践中，心脏瓣膜手术后心尖四腔室纵向应变的预后价值尚不确定。作者研究了在韩国一家三级医院接受心脏瓣膜手术的患者中，在真实世界实践中测量的左心室心尖四腔室纵向应变是否有助于预测术后结局。
这是一项观察性队列研究，纳入了 2014 年 1 月至 2018 年 12 月期间在韩国一家三级医院接受心脏瓣膜手术的患者。研究的暴露因素为术前左心室心尖四腔室纵向应变。主要结局是术后全因死亡率。
在 1773 例研究患者中（中位年龄 63 岁，女性占 45.9%），132 例（7.4%）在中位随访 27.2 个月时死亡。术前左心室心尖四腔室纵向应变与全因死亡率显著相关（校正后的危险比为绝对值每增加 1%，为 0.94；95%CI [0.90，0.99]，P=0.022），而左心室射血分数（LVEF）与全因死亡率无显著相关性（校正后的危险比：1.01，95%CI [0.99，1.03]，P=0.222）。此外，将左心室心尖四腔室纵向应变与 LVEF 和传统预后因素相结合，可改善全因死亡率的预测模型（P=0.022）。
在未患有冠状动脉疾病的接受心脏瓣膜手术的患者中，在真实世界临床实践中测量的左心室心尖四腔室纵向应变与术后生存独立相关。左心室纵向应变测量可能有助于瓣膜手术后的预后预测。
