513920 research-article2013

PRF29510.1177/0267659113513920PerfusionDurmaz et al.

Original Paper

Effect of coronary artery bypass surgery on left ventricular function as assessed by strain and strain rate imaging

Perfusion 2014, Vol. 29(5) 425­–433 © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0267659113513920 prf.sagepub.com

T Durmaz,1 H Bayram,2 NA Bayram,1 C Sari,1 T Keles,1 S Bastug1 and E Bozkurt1

Abstract Introduction: This study examined the effect of coronary artery revascularization on left ventricular function and the results of strain imaging for the detection of ischemia before and after coronary artery bypass graft (CABG) surgery. Material and Methods: Sixty-eight patients with a history of coronary artery disease (CAD) were included, prospectively. Conventional echocardiography and color tissue Doppler-derived strain-strain rate echocardiographic imaging were performed 24 hours before and 3 months after CABG surgery. Results: While strain rate values of the basal septum, middle segment of the lateral wall, middle segment of the inferior wall, and middle and basal segments of the anterior wall were significantly increased, other segments did not change after the operation. The mean systolic strain rate value was significantly increased after the operation. Left ventricle strain values in the middle segment of the septum, middle and basal segments of the inferior wall, and middle and basal segments of the anterior wall were significantly increased after the operation. No significant difference was noted in the basal septum or the middle and basal segments of the lateral wall after the operation. The mean systolic strain value was significantly increased after the operation. Conclusion: The results of this study suggest that strain and strain rate echocardiography can provide an accurate evaluation of regional contractile function after CABG, even in the segments that are apparently normal. Keywords coronary artery bypass grafting; Doppler echocardiography; left ventricle; off-pump coronary artery bypass; ventricular function

Introduction Coronary artery revascularization is the procedure of choice for patients with left main coronary artery disease and for patients with multi-vessel disease.1 Myocardial function may be depressed after surgery, even in the current era of improved surgical technique and myocardial protection.2 Left and right ventricular function has been reported to be impaired for several hours following cardiac surgery with cardiopulmonary bypass (CPB), probably as a result of the effects of cardioplegia, myocardial ischaemia, hypothermia-induced vasoconstriction and reperfusion injury.3 CPB with cardioplegic arrest has been suggested to induce inflammatory responses,4 cognitive dysfunction, myocardial stunning5 and increased left ventricular (LV) end-diastolic pressures,6 all having a potential negative impact on morbidity and mortality.

The evaluation of left ventricular systolic function and regional ischemia is traditionally based on visual 1Department

of Cardiology, Ataturk Education and Research Hospital, Ankara, Turkey 2Department of Cardiovascular Surgery, Ataturk Education and Research Hospital, Ankara, Turkey Corresponding author: Huseyin Bayram Department of Cardiovascular Surgery Ataturk Education and Research Hospital Hayat Sebla Apt D Block, 1425. Cad, No: 30/17 Cukurambar Ankara 06520 Turkey. Email: [email protected]

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estimation (eyeballing), wall motion index (WMI), Simpson’s Biplane method and Doppler tissue imaging. These tests, however, are either subjective, dependent upon operator experience or are time consuming.7–9 This has well-documented limitations for both the interobserver variability10 and the ability of the human eye to resolve rapid, short-lived motion.11 Another approach to defining the regional myocardial properties could be to evaluate the deformation of a myocardial segment during the cardiac cycle. Two parameters that reflect myocardial deformation properties can be extracted from the cardiac ultrasound data, the regional strain and the strain rate. The aim of this study was to examine the effect of coronary artery revascularization on left ventricular function and determine the diagnostic value of strain imaging for the detection of ischemia before and after CABG.

Material and Methods Sixty-eight patients with a history of coronary artery disease were included, prospectively and consecutively. The CABG operation was at the surgeon’s discretion, on-pump or off-pump CABG. Exclusion criteria were a history of myocardial infarction (MI) within the last month, left ventricular ejection fraction

Effect of coronary artery bypass surgery on left ventricular function as assessed by strain and strain rate imaging.

This study examined the effect of coronary artery revascularization on left ventricular function and the results of strain imaging for the detection o...
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