Predictive Value of Preoperative Myocardial Strain Imaging on Post-CABG Recovery

Muhammad Hassam Mehdi; Irfan Nawaz; Aqsa Javed; Hira Saif; Aiman Durrani; Seemab Naz

doi:10.61919/w4r33231

Authors

Muhammad Hassam Mehdi Resident, Peshawar General Hospital, Peshawar, Pakistan Author
Irfan Nawaz Resident Adult Cardiology, Prince Sultan Cardiac Center Hassa, Saudi Arabia Author
Aqsa Javed Bahria University Health Sciences, Karachi, Pakistan Author
Hira Saif Postgraduate Resident, Punjab Institute of Cardiology, Lahore, Pakistan Author
Aiman Durrani MBBS Graduate, Ziauddin University, Karachi, Pakistan Author
Seemab Naz MBBS Final-Year Student, Ningxia Medical University, Yinchuan, China Author

DOI:

https://doi.org/10.61919/w4r33231

Keywords:

Coronary Artery Bypass Grafting; Global Longitudinal Strain; Speckle-Tracking Echocardiography; Cardiac Output; Low Cardiac Output Syndrome; Intensive Care Unit; Postoperative Complications

Abstract

Background: Conventional left ventricular ejection fraction may not identify subtle myocardial dysfunction relevant to recovery after coronary artery bypass grafting. Global longitudinal strain provides a quantitative measure of myocardial deformation and may offer complementary prognostic information. Objective: To evaluate the association of preoperative global longitudinal strain with early postoperative cardiac output, intensive care unit stay, and complications following elective isolated coronary artery bypass grafting. Methods: This retrospective cohort study included 110 adults who underwent CABG at a tertiary cardiac centre in Central Punjab, Pakistan, between January 2022 and December 2024. Preoperative absolute GLS magnitude was classified as severely impaired (<11.0%), moderately impaired (11.1%–14.0%), or mild-to-preserved (>14.0%). Outcomes included early cardiac output, ICU stay, low cardiac output syndrome, new-onset atrial fibrillation, acute kidney injury, and a composite of postoperative complications. Group comparisons and adjusted regression analyses were performed. Results: ICU stay was 76.4 ± 20.5, 56.2 ± 14.8, and 49.1 ± 11.2 hours across severe, moderate, and mild-to-preserved GLS groups, respectively (p < 0.001). Corresponding cardiac output values were 3.9 ± 0.6, 4.6 ± 0.7, and 5.1 ± 0.7 L/min (p < 0.001). Low cardiac output syndrome occurred in 36.0%, 10.4%, and 0.0%, respectively (p < 0.001). Each one-percentage-point reduction in absolute GLS magnitude was associated with greater odds of postoperative complications (adjusted OR = 1.45, 95% CI: 1.12–1.88; p = 0.005). Conclusion: Impaired preoperative GLS was associated with poorer early recovery after CABG independently of baseline ejection fraction. Prospective validation is required before routine GLS-guided perioperative management can be recommended

References

1. Olsen FJ, Lindberg S, Pedersen S, Iversen A, Davidovski FS, Galatius S, et al. Global longitudinal strain predicts cardiovascular events after coronary artery bypass grafting. Heart. 2021;107(10):814–21. doi:10.1136/heartjnl-2020-318462.

2. Benson MJ, Silverton N, Morrissey C, Zimmerman J. Strain imaging: an everyday tool for the perioperative echocardiographer. J Cardiothorac Vasc Anesth. 2020;34(10):2707–17. doi:10.1053/j.jvca.2019.11.035.

3. Castillo RL, Farías J, Sandoval C, González-Candia A, Figueroa E, Quezada M, et al. Role of NLRP3 inflammasome in heart failure patients undergoing cardiac surgery as a potential determinant of postoperative atrial fibrillation and remodeling: is SGLT2 cotransporter inhibition an alternative for cardioprotection? Antioxidants (Basel). 2024;13(11):1388. doi:10.3390/antiox13111388.

4. Nagata Y, Wu VC, Otsuji Y, Takeuchi M. Feasibility, reproducibility, and clinical implications of the novel fully automated assessment for global longitudinal strain. J Am Soc Echocardiogr. 2021;34(2):136–45.e2.

5. Duncan AE, Alfirevic A, Sessler DI, Popović ZB, Thomas JD. Perioperative assessment of myocardial deformation. Anesth Analg. 2014;118(3):525–44. doi:10.1213/ANE.0000000000000088.

6. Yingchoncharoen T, Agarwal S, Popović ZB, Marwick TH. Normal ranges of left ventricular strain: a meta-analysis. J Am Soc Echocardiogr. 2013;26(2):185–91. doi:10.1016/j.echo.2012.10.008.

7. Aasim M, Aziz R, Mohsin A, Khan R, Zahid A, Awais M, et al. Outcomes of Coronary Artery Bypass Grafting in Patients With Impaired Left Ventricular Function and the Role of Preoperative Myocardial Viability. Cureus. 2024.

8. Arian F, Amini M, Mostafaei S, Kalantari KR, Avval AH, Shahbazi Z, et al. Myocardial Function Prediction After Coronary Artery Bypass Grafting Using MRI Radiomic Features and Machine Learning Algorithms. Journal of digital imaging. 2022.

9. Fu W, Zhao Y, Zhang K, Dai Q, Biekan J, Zheng J, et al. Retrospective, observational analysis of cardiac function associated with global preoperative myocardial scar in patients with ischemic cardiomyopathy after coronary artery bypass grafting. J Thorac Dis. 2022;14(11):4319-28.

10. Ganaev KG, Vlasova E, Avalyan A, Saidova MA, Akchurin R. First experience of using two-dimensional speckle-tracking echocardiography to assess the association of left atrial strain with atrial fibrillation after coronary artery bypass grafting. Russian Journal of Cardiology. 2022.

11. Granchietti AG, Ciardetti N, Mazzoni C, Garofalo M, Mazzotta R, Micheli S, et al. Left atrial strain and risk of atrial fibrillation after coronary artery bypass-grafting. International Journal of Cardiology. 2025;422:132981.

12. Jiang Z, Zhang M, Qin Y-y, Li Y, Lu X-Z. Usefulness of layer-specific strain for evaluating and predicting recovery of left ventricular myocardial function in patients undergoing hybrid coronary revascularization. The International Journal of Cardiovascular Imaging. 2022.

13. Kang H-U, Nam J-S, Kim J-H, Chin J, Choi I. Incremental Prognostic Value of Left Ventricular Longitudinal Strain Over Ejection Fraction in Coronary Artery Bypass Grafting. Journal of Cardiothoracic and Vascular Anesthesia. 2022.

14. Papestiev V, Jovev S, Risteski P, Popov A, Sokarovski M, Andova V, et al. Myocardial Function after Coronary Artery Bypass Grafting in Patients with Preoperative Preserved Left Ventricular Ejection Fraction—The Role of the Left Ventricular Longitudinal Strain. Medicina. 2023.

15. Pastore MC, Degiovanni A, Grisafi L, Renda G, Sozzani M, Giordano A, et al. Left Atrial Strain to Predict Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting. Circ: Cardiovascular Imaging. 2024;17(1).

16. Vyff F, Johansen N, Olsen F, Duus L, Lindberg S, Fritz-Hansen T, et al. Left atrial reservoir strain predicts ischaemic stroke after coronary artery bypass grafting independent of postoperative atrial fibrillation. European Heart Journal Open. 2022.