Prognostic Value of Strain Echocardiography for the Prediction of Survival after Left Ventricular Aneurysmectomy

Objectives: Our purpose was to evaluate the role of speckle-tracking echocardiography for the prediction of survival after surgical ventricular repair (SVR).

Methods: Two hundred thirty patients (2005–2018, mean age 63.7 ± 11.1 years, 73.2% males) with anteroapical left ventricle (LV) aneurysm after myocardial infarction underwent SVR combined with coronary artery bypass grafting (77%), mitral valve repair (18%) and LV thrombectomy (21%). Echocardiography was performed before SVR. Strain was quantified retrospectively and was available for 142 patients.

Results: Patients were followed up to 10 years (mean time 4.3±3.2 years, median 4.1 years, IQR: 1.07–7.1 years). Ten patients were lost to follow-up. Thirty-day survival rate was 92.7% (95% CI: 88.4; 95.5) and 5-year survival 71.3% (95% CI: 64.0–77.5). Patients who died were significantly older and more often had diabetes (DM), peripheral artery disease, renal failure (RF) and atrial fibrillation (AF). They had longer perfusion time and higher rate of complications after SVR. Patients who died had greater LV and left atrial (LA) volume. Baseline ejection fraction did not differ significantly. Risk stratification by tertiles revealed that GLS, longitudinal strain rate (LSR) at basal level of LV, right ventricle (RV) strain and LA strain were significant predictors of survival based on Kaplan–Meier curves. The risk of dying increased with decreasing tertile of GLS strain, being approximately 3 times higher for patients in the lowest tertile compared with patients in the highest tertile (HR: 2.94, 95% CI: 1.37; 6.25, p = 0.013). When adjusted to potential confounders (age, AF, DM, previous heart surgery, and RF) using Cox proportional hazard model, GLS still was an independent predictor of death (HR = 1.12, 95% CI: 1.004; 1.25, p = 0.043). Basal LSR also appeared to be an independent predictor of survival after adjustment to potential confounders, with HR of 1.26 (95% CI: 1.04; 1.52, p = 0.018). LA and RV strain also were independent predictors of survival when additional confounders were applied (HR of 0.71, 95% CI: 0.52; 0.96, p = 0.026 and HR of 1.11, 95% CI: 1.01; 1.22, p = 0.048, correspondingly). In this model, each increase of LA strain by 5% was associated with decrease in risk of death by 29%.

Conclusions: This study demonstrates a predictive role of strain parameters for survival after SVR. GLS, LSR at basal level of LV, RV strain, and LA strain are independent predictors of all-cause mortality in this group of patients.