• Edith L Posada-Martinez, Juan F Fritche-Salazar, Jose A Arias-Godinez, Xochitl A Ortiz-Leon, Karla Balderas-Muñoz, Maria Eugenia Ruiz-Esparza, Eduardo Arias Sánchez, Juan Pablo Sandoval, Ana Karla Tobias Morales, and Hugo Rodriguez-Zanella.
• Echocardiography Laboratory, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico.
• J. Cardiothorac. Vasc. Anesth. 2021 Jun 1; 35 (6): 1638-1645.

ObjectivesThe aim of this study was to analyze whether right ventricular free wall longitudinal strain (RVFWSL) could be a predictor of low-cardiac-output syndrome (LCOS) after surgical aortic valve replacement (SAVR) in patients with left ventricular ejection fraction ≥40%.DesignProspective, observational study.SettingThe study was conducted at a third level university hospital.ParticipantsThe study comprised 75 patients with severe aortic stenosis and LVEF ≥40% who underwent SAVR. The primary outcome was the occurrence of LCOS, and secondary outcomes were in-hospital mortality, hospital stay, or vasoplegic syndrome.InterventionsPatients were divided into two groups (LCOS and no LCOS), and RVFWSL was analyzed to determine whether it is a predictor for LCOS. In addition, a receiver operating characteristic curve also was constructed, and the best cutoff value to predict LCOS was found. Furthermore, the reproducibility of RVFWSL measurements was evaluated.Measurement And Main ResultsThe incidence of LCOS was 20% in the present study's cohort. After multivariate analysis, cross-clamp time (odds ratio 1.06, 95% confidence interval 1.02-1.11; p = 0.002) and RVFWSL (odds ratio 1.41, 95% confidence interval 1.07-1.87; p = 0.015) were the only predictors of LCOS. However, RVFWSL did not show association with secondary outcomes (p > 0.05 for all). The area under the curve of RVFWSL to predict LCOS was 0.75, and the best cutoff value was -17.3%, with a sensitivity of 86.7% and specificity of 61.7%.ConclusionsRVFWSL seems to be a predictor of LCOS in patients with severe aortic stenosis and LVEF ≥40% undergoing SAVR. RVFWSL less than -17.3% may identify patients at increased risk for LCOS.Copyright © 2020 Elsevier Inc. All rights reserved.

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