Left ventricular longitudinal strain for perioperative cardiac monitoring in aortic aneurysm surgery using transthoracic 2-dimensional echocardiography: a feasibility and repeatability study

Abstract

Objective: This study investigated perioperative echocardiographic image quality, the feasibility, and intra- and interobserver repeatability of left ventricular longitudinal two-dimensional strain echocardiography (2DSE) in aortic aneurysm surgery.

Design: A prospective, descriptive method evaluation.

Setting: A single-center study.

Participants: Eighteen patients undergoing elective open infrarenal aortic aneurysm repair.

Intervention: No intervention was made.

Measurements and main results: Four echocardiographic examinations were made: E1, preoperatively; E2, within 4 hours after surgery; E3, the first postoperative day; and E4, the second postoperative day. Four-chamber, 2-chamber, and longitudinal axis apical views were achieved. Image quality was scored visually on a scale from 1 to 5 with 5 as the best, and the 2-dimensional strain echocardiography (2DSE) software was applied to measure peak systolic strain. Blinded analyses were performed twice by 1 observer and once by a second observer. Image quality decreased significantly after surgery as compared with the preoperative examination, but 72% of patients had at least 1 image scoring >/=3 through all examinations. The software was able to measure the segmental and global left ventricular peak systolic strain in 80% and 61%, respectively, for the first observer and 71% and 26%, respectively, for the second observer. The coefficients of repeatability for intra- and interobserver measurements were 5.5% and 7.3% for segmental strain and 1.6% and 3.5% for global strain. 2DSE was more feasible and repeatable when echocardiographic images were good.

Conclusion: Feasibility and repeatability of 2DSE is good but affected by image quality. This study shows that 2DSE can be used in a clinical setting.