Early Effect of Surgical Revascularisation on Left Ventricular Twist Function
DOI:
https://doi.org/10.17987/icfj.v4i0.125Abstract
The direct effect of coronary artery bypass graft (CABG) surgery on early recovery of myocardial function, particularly twist and rotation is not well studied.
Aim: To assess the early response of the 3 myocardial components, circumferential, longitudinal and oblique to CABG in patients with isolated coronary disease.
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.
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).
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).
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.
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