Strain Study in Patients after Surgical Ventricular Repair: Prognostic Role of Strain Parameters and Evaluation of Left-Ventricle Remodeling

Objectives: The aim of this study was to evaluate the prognostic role of left ventricle (LV) global (GLS) and basal longitudinal strain (BLS) and to assess LV remodeling during first year after surgical ventricular repair (SVR) due to anteroapical LV aneurysm.

Methods: 226 patients (2005–2019; age, 63.6 ± 11.3 years, 73.9% males) with anteroapical LV aneurysm underwent SVR combined with coronary bypass grafting (76.1%), mitral valve repair (19%), and LV thrombectomy (21.7%). Baseline strain measurement was performed for 163 patients. Follow-up echocardiography was done for 50 patients at median time 11.9 months (IQR: 9–14.2 months). Patients were followed-up to 10 years for all-cause mortality.

Results: At 1-year follow-up considerable reduction of LV end-diastolic (LVEDVI) and end-systolic volume indexes (LVESVI; 110.4 ± 35.1 vs. 79.1 ± 22.1 mL/m², and 74.5 ± 31.5 vs. 48.5 ± 20.7 mL/m², correspondingly, p < 0.0001) and improvement of LV ejection fraction (EF) from 34.5 ± 9.2 to 43.2 ± 12.4% (p < 0.0001) were observed. The mean systolic GLS improved from −6.6 ± 2.7% to −8.3 ± 3.1% (p = 0.004). NYHA class reduced from 2.8 ± 0.7 to 1.96 ± 0.9 (p < 0.0001). Hypokinetic segments out of aneurysm with preserved strain had better recovery, measured by visual assessment and strain. During a median follow-up of 5.3 years (IQR: 1.8–9 years) there were 91 deaths. 30-day survival rate was 94.2% (95% CI: 90.3–96.9%), 5-year survival 73.7% (95% CI: 67–79%). Patients who died at year 5 were significantly older, with a higher proportion of diabetes (DM), peripheral artery disease and renal failure. Baseline EF, LVEDVI, LVESVI, and GLS did not differ, whereas BLS was higher (more negative which means more shortening) in survivors (−9.96 ± 3.5% vs. −11.3 ± 2.9%, p = 0.03). BLS of −7.3% was identified as a cut-off for prediction of 5-year mortality. Patients with lower BLS and LVESVI ≥ 60 mL/m² had the worse 5-year survival (33.3%), whereas pts with higher BLS had better survival both in the group with lower and greater LVESVI (74.4 and 72.9%, correspondingly). After adjustment for age, NYHA class, atrial fibrillation, DM, and creatinine, BLS was an independent predictor of death (HR = 0.8, 95% CI: 0.67–0.96, p = 0.018). Each increase of BLS by 2% resulted in a decrease of risk of dying by 20%.

Conclusion: At 1-year follow up after SVR significant reduction of NYHA class, an increase of ejection fraction, decrease on LV volumes, improvement of GLS and LV synergy was observed. Preserved BLS associated with lower mortality even if LV is severely enlarged, and could be used to evaluate the potential benefit of SVR in patients with anteroapical LV aneurysm.