Prediction of Left Ventricular Systolic Dysfunction after 6 months of Aortic Valve Replacement in patients with Chronic Severe Aortic Regurge

Abstract

Introduction: LVEF as a surrogate for myocardial performance is problematic in chronic AR as it is augmented by increased preload. Therefore, we need noninvasive parameters to assess myocardial function in altered loading conditions. We aim to assess the validity of new echo-Doppler indices for prediction of postoperative LV dysfunction 6 months after AVR. Methods: We recruited 20 patients with severe isolated AR with LVEF >50%, prepared for AVR. Echocardiographic examination was done 48hours before and 6 months after AVR. Early diastolic driving force “DF”, Global longitudinal strain “GLS” and Left ventricular ejection fraction “LVEF” by modified biplane Simpson method were measured. Our patients were classified according to postoperative LVEF into Group A (15 cases); normal (postoperative LVEF≥50%) and Group B (5 cases); postoperative LV systolic dysfunction (postoperative LVEF<50%). Results: Preoperative DF was 0.20 ± 0.12 Newton in group A while it was 0.66 ± 0.28 Newton in group B, this difference was statistically significant (t=3.5, p<0.05). EF was 62.73 ± 6.64% in-group A while it was 53.2± 2.77% in-group B, this difference was statistically highly significant (t=4.50, p<0.001). GLS was -18.95 ± 2.55% in-group A while it was -12.56 ± 2.04% in group B, this difference was statistically highly significant (t=5.04, p<0.001).On plotting the ROC curves, it was clear that preoperative GLS and DF are strong predictors of post-operative systolic dysfunction in such cases. Conclusion: Preoperative GLS and DF seem to be independent predictors for postoperative LV systolic dysfunction after AVR for chronic severe AR. Introduction The natural history of chronic severe aortic valve regurgitation (AR) is characterized by a prolonged period of preserved global left ventricular (LV) systolic function and compensated eccentric hypertrophy, which insidiously gives way to myocardial decompensation [1]. In its early stages, myocardial dysfunction may be reversible once implantation of a mechanical or bioprosthetic aortic valve eliminates the volume load. If left untreated, myocardial dysfunction becomes irreversible, a condition associated with high rates of morbidity and mortality [2]. The choice Prediction of Left Ventricular Systolic Dysfunction after 6 months of Aortic Valve Replacement in patients with Chronic Severe Aortic Regurge Article Information Received date: Nov 06, 2018 Accepted date: Nov 19, 2018 Published date: Nov 21, 2018 Mohammad Gouda1*, Ahmed S Ammar1, Mohammad Hassan1, Abdel-Alwahab MF1 and Hassouna A2 1Cardiology Department, Faculty of Medicine, Zagazig University, Egypt 2Cardiothoracic Surgery, Ainshams University, Cairo, Egypt *Corresponding author Mohammad Gouda, Faculty of Medicine, Zagazig, Zagazig University, Cardiology Department, Egypt, 44519, Email: [email protected]