Improving risk assessment for post-surgical low cardiac output syndrome in patients without severely reduced ejection fraction undergoing open aortic valve replacement. The role of global longitudinal strain and right ventricular free wall strain

Abstract

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.

Risk factors for low cardiac output syndrome in children with congenital heart disease undergoing cardiac surgery: a retrospective cohort study

“…The effect of age on the risk of LCOS in adults has been confirmed earlier. In a prospective study, multivariate analysis showed that age was an independent predictor of LCOS [9] and a retrospective study ascertained that increasing age is an independent predictor of LCOS [2].…”

“…Prediction models based on clinical data, such as EuroSCORE, have been proposed [8]. However, the risk factors of LCOS are varied in the literature according to the population and surgery categories included [2,[9][10][11].…”

Implications of myocardial dysfunction before and after aortic valve intervention

“…Both systolic and diastolic function has been found to impact the outcome of an aortic valve intervention 79,80 . Previous studies have identified both pre-and intraoperative risk factors for PHF [81][82][83] . Studies on patients that have undergone non-cardiac surgery have shown that the best therapeutic approach to heart failure in the surgical setting is to perform proper patient risk stratification 84 .…”

“…Pre-and postoperative characteristics. 70 [65][66][67][68][69][70][71][72][73][74][75][76] 75 [68][69][70][71][72][73][74][75][76][77][78][79] 0.08 60 <0.001 82 [76][77][78][79][80][81][82][83][84][85] Values are given as n (%) and median (25 th to 75 th percentile).…”

A nomogram to predict the risk of low cardiac output syndrome after heart valve replacement in cardiac valvular disease patients

“…Low cardiac output syndrome (LCOS) is the most serious complication, which associated with increased morbidity, and treatment-related costs [5]. Recent studies suggest a wide LCOS incidence of 3.9-41% [3,6,7]after heart valve surgery. For these patients, LCOS is associated with a 30-day mortality rate of 12.8-38% [3,6,8].…”