Early Effect of Surgical Revascularisation on Left Ventricular Twist Function
Authors: Ramzy Ihab S , Gustafsson Sandra , Holmgren Anders , Lindqvist Per , Henein Michael Y 
Published: December 2015

<p style="margin: 0cm 0cm 10pt; text-align: justify;"> </p><p style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: 'Times New Roman','serif';"><span style="font-size: medium;">The direct effect of coronary artery bypass graft (CABG) surgery on early recovery of myocardial function, particularly twist and rotation is not well studied. </span></span></p><p style="margin: 0cm 0cm 10pt; text-align: justify;"> </p><p style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: 'Times New Roman','serif';"><span style="font-size: medium;">Aim: To assess the early response of the 3 myocardial components, circumferential, longitudinal and oblique to CABG in patients with isolated coronary disease.</span></span></p><p style="margin: 0cm 0cm 10pt; text-align: justify;"> </p><p style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: 'Times New Roman','serif';"><span style="font-size: medium;">Methods: We studied 14 patients, age 64±10 years, before CABG and before hospital discharge using various Doppler echocardiographic techniques including speckle tracking, and compared them with 28 age matched controls.</span></span></p><p style="margin: 0cm 0cm 10pt; text-align: justify;"> </p><p style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: 'Times New Roman','serif';"><span style="font-size: medium;">Results: Before surgery: Compared to controls, patients had significantly reduced LVEF (p=0.01) but maintained stroke volume (SV) (p=0.5). Diastolic LV function indices were statistically abnormal (p=0.01). LV lateral wall long axis amplitude and myocardial systolic velocities were both reduced (p=0.01) as was septal amplitude of motion (p=0.05). LV peak global longitudinal strain (GLS) was reduced as were systolic and early diastolic global longitudinal strain rates (p=0.01 for all). LV peak basal and apical rotations, twist and torsion were not different. Q-peak basal rotation was shorter than controls (p=0.01).</span></span></p><p style="margin: 0cm 0cm 10pt; text-align: justify;"> </p><p style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: 'Times New Roman','serif';"><span style="font-size: medium;">After surgery: None of these measurements changed except peak GLS which further reduced (p=0.01). Pre-operatively, SV correlated with global LV function: twist (r= -0.65, p=0.01), and LV torsion (r=-0.66, p=0.01) but LVEF did not correlate with either. Post-operatively, SV correlated with E/A ratio (r=0.66, p=0.01), and the time interval Q- peak basal rotation rate (r=0.8, p=0.002).</span></span></p><p style="margin: 0cm 0cm 10pt; text-align: justify;"> </p><p style="margin: 0cm 0cm 10pt; text-align: justify;"><span style="font-family: 'Times New Roman','serif';"><span style="font-size: medium;">Conclusion: CABG does not result in significant early segmental LV functional improvement along its three myocardial components, but SV becomes dependent on early basal rotation and filling pressures.</span></span></p><p style="margin: 0cm 0cm 10pt; text-align: justify;"> </p>