Systolic heart function remains depressed for at least 30 days after on-pump cardiac surgery.
OBJECTIVE
The myocardial recovery time following on-pump cardiac surgery remains uncertain. Global peak longitudinal strain is a sensitive measure of endocardial function which is most susceptible to ischaemia. We aimed to evaluate changes in global peak longitudinal strain up to 6 months after surgery and to compare initial changes with alterations in troponin T. Secondarily, we aimed to describe perioperative changes in strain of the inter-ventricular septum when compared with reference segments.


METHODS
Patients scheduled for coronary bypass, aortic valve replacement or combination procedures were enrolled. Echocardiography was performed on the day before surgery, the day after surgery, 4 days after surgery, 30 days after surgery and 6 months after surgery. Troponin T was measured 3, 16 and 24 h following procedure.


RESULTS
Forty patients were enrolled and one was later excluded. Global peak longitudinal strain decreased from -14.5 ± 3.33% preoperatively to -9.98 ± 3.09% and -10.57 ± 3.16% on the first and fourth postoperative day, respectively. Global strain was still reduced on the 30th postoperative day, but had returned to preoperative values 6 months after surgery. Absolute values and relative changes in global strain did not correlate with postoperative peak troponin T measurements. Strain of the inter-ventricular septum was unaffected by surgery as opposed to reference segments, although septal displacement in the longitudinal direction decreased from 12.0 ± 3.75 mm preoperatively to 3.58 ± 4.22 mm 4 days after surgery.


CONCLUSIONS
Global peak longitudinal strain was reduced for at least 30 days after on-pump cardiac surgery and seems to represent a more sensitive marker of myocardial function than ejection fraction. The decrease in global strain was not reflected in troponin T measurements. The visual, echocardiographic impression of septal dysfunction may be a translational phenomenon, as septal strain was unaffected by surgery.
Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Skejby, Aarhus N, Denmark. peter.juhl-olsen@ki.au.dk
Peter
P
Juhl-Olsen
Rajesh
R
Bhavsar
Christian Alcaraz
CA
Frederiksen
Erik
E
Sloth
Carl-Johan
CJ
Jakobsen
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011379:Prognosis; D013599:Systole; D013997:Time Factors; D018754:Ventricular Dysfunction / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D016276:Ventricular Function / Q000502:physiology*