Assessment of Left Ventricular Reverse Remodeling and Functional Improvement after Surgical Ventricular Repair by Two-Dimensional Speckle-Tracking Echocardiography

Objectives: The aim of the study was to evaluate the short-term results of surgical ventricular repair (SVR) in patients with ischemic cardiomyopathy in terms of change of volumetric parameters, left ventricle mechanics, and function as assessed by two-dimensional echocardiography.

Methods: Patients (n = 69, mean age 58.9 ± 10.6 years, 76.8% males) with LV anteroapical aneurysm after myocardial infarction were examined by 2D echocardiography with 2D speckle tracking before and after SVR: within 1 month (n = 54, mean time 11.0 ± 7.8 days) and at 1 year (n = 21, mean time 15.1 ± 7.0 months). Parameters assessed were global longitudinal systolic strain (GLS), longitudinal strain rate (GLSr) and peak systolic velocity (PSV), variability of time to peak LS (TPSsd), dyssynergy index (ratio of standard deviation of mean end-systolic LS to mean end-systolic LS), and postsystolic shortening (PSS).

Results: SVR was performed using modified Dor technique (combined with coronary artery bypass grafting in 68.1% of patients and with mitral valve repair in 30%). Significant reduction of LV end-diastolic (LVEDVI) and LV end-systolic volumes indexes (LVESVI) (129.9 ± 45.5 vs. 84.4 ± 26.3 mL/m² and 92.3 ± 40.4 vs. 53.3 ± 23mL/m², correspondingly, p < 0.0001) and improvement of LV ejection fraction (LVEF) (from 30.9 ± 9.2 to 38.3 ± 9.4, p < 0.0001) were observed within 1 month after SVR. There was an increase in GLSr (−0.51 ± 0.14 s⁻¹ vs −0.58 ± 0.17 s⁻¹, p = 0.016) and also a decrease in proportion of segments with PSS (43 ± 20 vs. 30 ± 18%, p = 0.0004) and mean PSV (0.11 ± 1.5 vs. 0.87 ± 1.3 cm/s, p = 0.024), but no significant changes in GLS, mean PSV, or dyssynchrony parameters were found early after SVR. At 1-year follow-up, reduction of LVESVI and LVESVI and improved LVEF remained preserved. The mean GLS improved compared to baseline (−5.9 ± 2.9 vs. −8.03 ± 3.2%, p = 0.007). A further increase of the mean GLSr and PSV was also observed. No change in TPSsd, but significant decrease in dyssynergy index was found (1.12 ± 0.6 vs. 0.79 ± 0.4, p = 0.037). Proportion of segments with PSS pattern was lower than at baseline.

Conclusion: Two-dimensional echocardiography with speckle-tracking assessment of LV longitudinal function reveals a significant and stable LV volume reduction with increase of LVEF and improvement of both GLS and synergy of contraction at 1-year follow-up after SVR. Strain imaging clearly shows the benefits for LV function obtained through SVR.