Echocardiographic Predictors of Immediate Postoperative Outcomes in Patients With Severe Left Ventricular Systolic Dysfunction Undergoing On-Pump Coronary Artery Bypass Grafting

Jha, Ajay Kumar; Malik, Vishwas; Gharde, Parag; Chauhan, Sandeep; Kiran, Usha; Hote, Milind Padmakar

doi:10.1053/j.jvca.2016.04.025

Cited by 19 publications

(12 citation statements)

References 24 publications

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“…Despite improved surgical and myocardial protection techniques, some patients have persistent LV dysfunction in the immediate postoperative period after CABG. Although successful revascularization should improve myocardial function, systolic function declines or fails to improve in the postoperative period in up to one‐third of patients 5‐7 . In a study of 135 patients, 35% had unchanged or greater than 5% reduction in LV EF postoperatively (16 ± 33 days) after CABG 22 .…”

Section: Discussionmentioning

confidence: 99%

“…LV systolic dysfunction is a strong predictor of adverse clinical outcomes for patients undergoing CABG 3,4 . It is well known that postoperative LV dysfunction augments perioperative risk as evidenced by an array of studies showing that patients with persistent systolic dysfunction have increased rates of vasopressor support as well as the use of intraoperative balloon pump 5‐7 . This highlights the importance of understanding underlying mechanisms of systolic dysfunction among patients undergoing CABG, specifically the impact of SAG versus MAG.…”

Section: Discussionmentioning

confidence: 99%

“…Traditional echo indices are limited in diagnosing LV dysfunction: there is conflicting evidence as to the magnitude and direction of change in systolic LV function after CABG 6,23 . Initial studies have shown promise for echo strain as being a reliable, feasible, and accurate predictor of outcomes after CABG 5,24 . To date, strain echo techniques have yet to be used to test the change in LV function from baseline to immediately postoperatively in a cohort of patients undergoing differential CABG revascularization strategies (MAG vs SAG).…”

Section: Discussionmentioning

confidence: 99%

“…Left ventricular (LV) function is known to predict prognosis after CABG 3,4 . After CABG, LV function improves for some patients but remains unchanged or decreases in up to 25% of others 5‐7 . The impact of different revascularization approaches on LV performance and on clinical outcomes is not completely understood.…”

Section: Introductionmentioning

confidence: 99%

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Differential myocardial strain in the early postoperative period in patients receiving arterial vs venous bypass grafts: A hypothesis‐generating study

et al. 2020

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Objective Revascularization via coronary artery bypass grafting (CABG) remains a common therapy for coronary artery disease. CABG‐based revascularization is most commonly performed via either single arterial graft (SAG) or multiple arterial grafting (MAG) strategies. Echo‐derived global and regional longitudinal strain was used to test where SAG or MAG results in immediate differences in left ventricular (LV) function after CABG. Materials and Methods Pre‐ and postprocedural intraoperative transesophageal echos were prospectively collected. Two‐dimensional LV images were analyzed for global and regional longitudinal strain (GLS), LV ejection fraction, end‐diastolic volume, end‐systolic volume, and stroke volume (SV). Results Twenty patients underwent open, on‐pump CABG (63.9 ± 10 years old, 85% male; 10 with SAG and 10 with MAG. Preprocedural GLS significantly differed between patients with SAG and MAG, with patients with MAG having greater GLS (mean [standard deviation, SD], 20.41 [5.54]) than patients with SAG (16.28 [3.48]). After CABG, in patients with MAG, LV strain decreased both globally (−1.13 [3.15]) and regionally in the anterior‐lateral (−1.22 [3.84]) and inferior‐lateral regions (−1.32 [5.69]), along with LVEF. In patients with SAG, LV strain increased after CABG globally (1.34 [2.73]) and regionally in the anterior‐lateral (1.20 [6.49]) and inferior‐lateral regions (0.39 [7.26]), as did LVEF and SV. Postprocedure, more patients with MAG were given vasopressor (100% vs 60%) and inotrope infusions (70% vs 40%) than patients with SAG. Conclusions After CABG, LV function quantified through GLS changes both globally and regionally increased after SAG and decreased after MAG. This finding may have important clinical implications in terms of optimizing intraoperative management for patients with CABG and have the potential to guide the improvement of clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Differential myocardial strain in the early postoperative period in patients receiving arterial vs venous bypass grafts: A hypothesis‐generating study

et al. 2020

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“…Despite these issues, there have been a few prior publications that show promise for intraoperative TEE-derived strain as a tool for LV functional assessment. Jha et al 10 compared a number of echocardiographic parameters for LV function obtained from the intraoperative TEE to determine which were most predictive of adverse cardiac outcomes after coronary artery bypass grafting, and found GLS to be the independent predictor with the highest OR. Another study by Kumar et al 11 found both 3-dimensional LV EF and GLS to be predictors of low cardiac output state after cardiac surgery.…”

mentioning

confidence: 99%

Beyond Ejection Fraction: The Role of Intraoperative Left Ventricular Strain Analysis

Feinman

2019

Journal of Cardiothoracic and Vascular Anesthesia

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Perioperative clinical utility of myocardial deformation imaging: a narrative review

Abuelkasem

Wang

Omer

et al. 2019

British Journal of Anaesthesia

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Preoperative cardiac function is an important predictor of postoperative outcomes. Patients with heart failure are at higher risk of perioperative morbidity and mortality. Left ventricular ejection fraction (LVEF), derived by standard echocardiography, is most frequently used to assess cardiac function in the intraoperative and postoperative periods. Myocardial strain analysis, a measurement of myocardial deformation, can provide additional information to LVEF estimation. Here, we provide an overview of myocardial strain and different methods used to evaluate strain, including speckle tracking echocardiography. Speckle tracking echocardiography is an imaging modality that can analyse and track small segments of the myocardium, which provides greater detail for assessing global and regional cardiac motion and function. We further review the literature to illustrate the value of speckle tracking echocardiography-derived myocardial strain in describing cardiac function and its association with adverse surgical outcomes in the perioperative period, including low cardiac output states, need for inotropic support, postoperative arrhythmias, subclinical myocardial ischaemia, and length of hospital stay.

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Echocardiographic Predictors of Immediate Postoperative Outcomes in Patients With Severe Left Ventricular Systolic Dysfunction Undergoing On-Pump Coronary Artery Bypass Grafting

Cited by 19 publications

References 24 publications

Differential myocardial strain in the early postoperative period in patients receiving arterial vs venous bypass grafts: A hypothesis‐generating study

Differential myocardial strain in the early postoperative period in patients receiving arterial vs venous bypass grafts: A hypothesis‐generating study

Beyond Ejection Fraction: The Role of Intraoperative Left Ventricular Strain Analysis

Perioperative clinical utility of myocardial deformation imaging: a narrative review

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