1036 Prognostic role of left ventricle longitudinal strain for the prediction of survival after surgical ventricular repair
Authors: Nemchyna O , Solowjowa N , Dandel M , Stein J , Hrytsyna Y , Knierim J , Soltani S , Schoenrath F , Falk V , Knosalla C 
Published: January 2020

Abstract

Background
Surgical ventricular repair (SVR) in patients with ischemic cardiomyopathy is aimed to reshape left ventricle (LV) and reduce its volume in order to improve prognosis and quality of life. There are controversies regarding benefit of SVR, especially in patients with severely enlarged LV.

Purpose
Our purpose was to investigate prognostic value of LV longitudinal strain for survival and for the improvement of LV function after SVR in patients with anteroapical LV aneurysm.

Methods
218 pts (2005-2018, mean age 63.6 ± 11.2y, 73.9% males) with anteroapical LV aneurysm due to myocardial infarction underwent SVR combined with coronary bypass grafting (77.5%), mitral valve repair (18.3%) and LV thrombectomy (22.0%). Preoperative strain analysis was done retrospectively for 146 patients. Prognostic value of strain was tested in pts according to the LV end systolic volume index (LVESVI) with the cut-off value of 60ml/m². In 17 pts 1-year follow-up with strain quantification was done.

Results
During a median follow-up of 3.9 years (IQR: 1.0-6.8 years) there were 68 deaths and 1 patient was lost to follow-up. 30-days survival rate was 93.5% (95%CI: 90.3; 96.9%), 5 year survival – 72.5% (95%CI: 66.0-79.6%). Pts who died were significantly older, with higher proportion of diabetes (DM), peripheral artery disease, renal failure (RF) and atrial fibrillation (AF). Baseline ejection fraction (EF) and global longitudinal strain (GLS) did not differ significantly. Whereas basal longitudinal strain (BLS) was higher (more negative) in pts who survived (-11.4 ± 3% vs. -10.1 ± 4%, p = 0.027). Risk stratification by tertiles revealed that BLS was a significant predictor of survival. The risk of dying was 3 times higher for pts in the lowest tertile compared to those in the highest tertile (HR: 2.94, 95%CI:1.37-6.25, p = 0.013). When adjusted to age, AF, DM, RF, and previous heart surgery, BLS was an independent predictor of death (HR = 1.14, 95%CI:1.03;1.26, p = 0.032). At 1-year follow-up (12.7 ± 5.1 months) there was significant decrease of LV end-diastolic and end-systolic volume indices, from 102.8 ± 24.1 ml/m² to 77.9 ± 24 ml/m² (p &lt; 0.001) and from 67 ± 23.2 ml/m² to 44.3 ± 7.6 ml/m² (p &lt; 0.001), correspondingly, and increase of EF from 36.3 ± 9.4% to 44.4 ± 7.6% (p = 0.001). The mean systolic GLS improved from -6.6 ± 2.6% to -8.7 ± 3.2%, p = 0.008. Among 81 segments with baseline hypokinesia, 44 segments (54.3%) recovered their contractility, 36 segments (44.4%) remained hypokinetic and 1 segment deteriorated to akinesia. Mean systolic strain of segments which showed recovery was -6.6 ± 4.0% compared to -3.8 ± 4.5% with no improvement (p = 0.005). Cut-off value of systolic strain for prediction of recovery was -5.4 % (AUC = 0.69, p = 0.004; PPV = 0.73, NPV = 0.61).

Conclusion
Our study demonstrates that BLS is an independent predictor of survival after SVR in patients with LV anteroapical aneurysm. Furthermore, higher systolic strain predicts recovery of LV regional function at 1-year after SVR.