In patients with severe aortic stenosis, the presence of left ventricular systolic dysfunction is one of the main predictors of adverse events after valve replacement surgery. However, more and more patients are being referred for surgery early and have preserved systolic function at the time of surgery. Within this category, global longitudinal strain (GLS) has been proposed as a marker of ventricular remodeling after cardiac surgery.
Our study aims to identify the variation of Global longitudinal strain (GLS) in patients undergoing aortic valve replacement and any differences compared to classes of diastolic dysfunction.
Methods From June 2020 to June 2022 we analyzed patients with severe aortic stenosis with an indication for cardiac surgery treatment admitted to the cardiac surgery department of our AOU. All patients underwent an echocardiogram immediately before surgery and in the early postoperative period (mean 7 days). In all cases, the GLS of the left ventricle was calculated and patients were divided into four classes according to the degree of diastolic dysfunction (0-III) according to the most recent international guidelines. The data were analyzed with SPSS 28 software. Analysis of variance was performed with a t-test and ANOVA test.
Results. In the final analysis, 63 patients were included, with a mean age of 70.5±8.2%, of whom 28 were women (44.4%) and 35 were men (55.6%). In 12 patients (19%) ischaemic heart disease with an indication for coronary revascularization was also present. The mean preoperative ejection fraction was 59±9.5%. The mean GLS values before surgery were 15.26±4.3% vs. early postoperative 12.52±2.6%, p<0.0001. GLS values were comparable within the various classes of diastolic dysfunction and preoperative examination (0 14.54±3.6%; I 16.04± 4.1%; II 15.27±4.7%; III 9.27%, p=0.39) and postoperative (0 12.28± 3.2%; 12.81±1.7%; II 12.53±2.9%; III 9.97%, p=0.73).
Conclusions In our case series, patients with severe aortic stenosis undergoing aortic valve replacement with or without myocardial revascularization show a significant early reduction in GLS regardless of the degree of diastolic dysfunction. An extension of follow-up is needed to assess any differences in the intervention's benefit in different diastolic dysfunction subgroups.