Left Ventricular Diastolic Function Assessed by Speckle Tracking Echocardiography in Patients with Left Ventricular Aneurysm

Background: In this study we aimed to evaluate novel parameters of LV diastolic function obtained by speckle-tracking echocardiography (STE) and their prognostic role in patients with left ventricular (LV) aneurysm planned for surgical ventricular restoration (SVR).

Method: We retrospectively examined data of 137 patients (60 ± 11 years, 25% women) with LV anteroapical aneurysm who underwent SVR. STE parameters evaluated were: early and late diastolic strain rate at basal level of left ventricle (BLSRe and BLSRa) and ratio of early diastolic transmitral flow velocity (E) to BLSRe and to BLSRa. In 24 patients we evaluated an association of echocardiographic parameters of LV diastolic function with mean pulmonary artery pressure (PAPm) and mean pulmonary capillary wedge pressure (PCWPm) obtained invasively. Preoperative echocardiographic parameters were assessed in whole cohort of patients for the association with an outcome, defined as all-cause mortality, LV assist device implantation, or heart transplantation.

Results: During a median follow-up of 4.7 years (IQR: 1.4–8.1 years) events occurred in 59 patients. BLSRa and E/BLSRa demonstrated significant correlation with PAPm (r = −0.8, p < 0.0001 and r = 0.69, p = 0.001) and with PCWPm (r = −0.65, p = 0.009 and r = 0.64, p = 0.01). BLSRa ≤0.74 second 1 was able to detect mean PAP ≥30 mm Hg with sensitivity of 90% and specificity of 80% (AUC 0.88; p = 0.004). E/BLSRa ≥0.94 m was able to detect mean PAP ≥30 mm Hg with sensitivity of 100% and specificity of 80% (AUC: 0.89; p = 0.003). There was significant difference in age adjusted event-free survival between groups stratified by cut-offs for BLSRa (HR = 1.9; p = 0.025) and E/BLSRa (HR = 2.1; p = 0.025). After adjustment for other important echocardiographic parameters (LV end-systolic volume index, fractional shortening, sphericity index and mitral insufficiency) BLSRa and E/BLSRa remained an independent predictors of events (HR: 0.34; p = 0.044 and HR 1.19; p = 0.019) and demonstrated higher prognostic value compared with conventional parameters of LV diastolic function.

Conclusion: Late diastolic longitudinal strain rate assessed at LV basal level and its derivative (E/BLSRa) demonstrated significant association with hemodynamic parameters in patients with LV anteroapical aneurysm and might be used for the evaluation of LV diastolic function. These parameters showed prognostic value for patients underwent SVR and could be implemented for their preoperative evaluation.

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Publikationsverlauf

Artikel online veröffentlicht:
03. Februar 2022