Preoperative systolic strain rate predicts postoperative left ventricular dysfunction in patients with chronic aortic regurgitation.
BACKGROUND
The best predictor for postoperative left ventricular (LV) systolic dysfunction in patients with chronic aortic regurgitation is still a matter of debate. The aim of this study was to assess the clinical significance of preoperative systolic radial strain rate (Ssr) derived from tissue Doppler echocardiography as a predictor of postoperative LV systolic dysfunction in patients with chronic aortic regurgitation.


RESULTS
In 52 patients (mean age, 58 years; 13 women) with isolated chronic aortic regurgitation, we performed standard and tissue Doppler echocardiography before and after operation, obtained echocardiographic parameters such as LV dimensions and LV ejection fraction, and measured Ssr in 4 walls of the LV. Linear regression analysis determined correlations between preoperative parameters and postoperative LV ejection fraction. Receiver-operating characteristic curve analysis assessed the optimal cutoff values of parameters that predicted postoperative LV systolic dysfunction (ejection fraction <50%). The operation caused significant decreases in LV dimensions and volumes and significant increases in Ssr (1.94+/-0.64 to 2.39+/-0.83 per second; P<0.001) and ejection fraction (53.0+/-8.7 to 59.0+/-8.8%; P<0.001). Multiple regression analysis demonstrated that averaged Ssr was the only independent predictor of postoperative LV systolic dysfunction among the covariates examined (P<0.001). Using receiver-operating characteristic curve analysis, averaged Ssr yielded the greatest area under the curve among preoperative parameters (0.80) and was indicated to be a good predictor of postoperative LV dysfunction, with 90.9% sensitivity and 73.2% specificity (cutoff value, 1.82 per second).


CONCLUSIONS
Measurement of preoperative averaged Ssr is useful in predicting postoperative LV systolic dysfunction and optimizing surgical timing in patients with isolated chronic aortic regurgitation.
Onishi
Tetsuari
T
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Kawai
Hiroya
H
Tatsumi
Kazuhiro
K
Kataoka
Toshiya
T
Sugiyama
Daisuke
D
Tanaka
Hidekazu
H
Okita
Yutaka
Y
Hirata
Ken-ichi
K
D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery; D016022:Case-Control Studies; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012372:ROC Curve; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*