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Prognostic value of preoperative left ventricular global longitudinal strain for predicting postoperative myocardial injury and mortality in patients undergoing major non-cardiac surgery (SOLOMON study)

Authors
 Minkwan Kim  ;  Inki Moon  ;  SungA Bae  ;  HyeSun Seo  ;  In Hyun Jung 
Citation
 INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol.378 : 151-158, 2023-05 
Journal Title
INTERNATIONAL JOURNAL OF CARDIOLOGY
ISSN
 0167-5273 
Issue Date
2023-05
MeSH
Aged ; Cardiovascular Diseases* ; Cohort Studies ; Echocardiography ; Female ; Global Longitudinal Strain* ; Humans ; Prognosis ; Prospective Studies ; Risk Factors ; Stroke Volume
Keywords
Global longitudinal strain ; Myocardial injury ; Non-cardiac surgery ; Prognosis
Abstract
Background: The usefulness of preoperative measurement of left ventricular global longitudinal strain (LVGLS) for predicting prognosis in patients undergoing non-cardiac surgery has not been evaluated. We analyzed the prognostic value of LVGLS in predicting postoperative 30-day cardiovascular events and myocardial injury after non-cardiac surgery (MINS). Methods: This prospective cohort study was conducted in two referral hospitals and included 871 patients who underwent non-cardiac surgery <1 month after preoperative echocardiography. Those with ejection fraction <40%, valvular heart disease, and regional wall motion abnormality were excluded. The co-primary endpoints were the (1) composite incidence of all-cause death, acute coronary syndrome (ACS), and MINS and (2) com-posite incidence of all-cause death and ACS. Results: Among the 871 participants enrolled (mean age: 72.9 years; female: 60.8%), there were 43 cases of the primary endpoint (4.9%): 10 deaths, 3 ACS, and 37 MINS. Participants with impaired LVGLS (<= 16.6%) had a higher incidence of the co-primary endpoints (log-rank P < 0.001 and 0.015) than those without. The result was similar after adjustment with clinical variables and preoperative troponin T levels (hazard ratio = 1.30, 95% confidence interval [CI] = 1.03-1.65; P = 0.027). In sequential Cox analysis and net reclassification index, LVGLS had an incremental value for predicting the co-primary endpoints after non-cardiac surgery. Among the 538 (61.8%) participants who underwent serial troponin assay, LVGLS predicted MINS independently from the traditional risk factors (odds ratio = 3.54, 95% CI = 1.70-7.36; P = 0.001). Conclusions: Preoperative LVGLS has an independent and incremental prognostic value in predicting early postoperative cardiovascular events and MINS. Clinical Trial Registration: URL: https://trialsearch.who.int/. Unique identifiers: KCT0005147.
Files in This Item:
T202302801.pdf Download
DOI
10.1016/j.ijcard.2023.02.046
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Minkwan(김민관) ORCID logo https://orcid.org/0000-0002-4079-8219
Bae, SungA(배성아) ORCID logo https://orcid.org/0000-0003-1484-4645
Jung, In Hyun(정인현) ORCID logo https://orcid.org/0000-0002-1793-215X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/194266
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