Evaluation of change in Left Ventricular Global Longitudinal Strain using Transthoracic Echocardiography in the perioperative period in patients undergoing open thoracic and abdominal aortic aneurysm

The evaluation of left ventricular (LV) function is a critical aspect ofmanaging patients undergoing aortic aneurysm surgery. Both thoracic andabdominal aortic aneurysms pose significant risks, and surgical intervention isoften the only viable option. The perioperative management of these patients iscomplex and necessitates thorough cardiovascular assessment to optimizeoutcomes.

Left ventricular global longitudinal strain (GLS) has emerged as asensitive and reliable parameter for assessing LV systolic function. Globallongitudinal Strain quantifies the myocardial deformation along the long axisof the left ventricle during systole and diastole, offering insights intomyocardial contractility and relaxation. A decrease in longitudinal strainoften precedes clinical symptoms, making it a sensitive indicator of earlycardiac dysfunction.6Thisis particularly pertinent in patients undergoing major vascular surgeries,where cardiac complications are a leading cause of morbidity and mortality.

2D Speckle trackingimaging, allow for the measurement of tissue velocity and deformation,providing high-quality, precise and objective information regarding regionaland/or global myocardial function in real-time. It also offers an angle-independentassessment of myocardial strain in three directions: radial, circumferential  and longitudinal9.

 Traditional methods foranalyzing LV systolic function are fractional shortening, fractional areachange, stroke volume and ejection fraction (EF) derived from 2D or Dopplerevaluation. Changes in LV GLS precede changes in other modalities such as EF,FAC and Stroke volume12, enabling early detection of subclinical myocardial dysfunction.

 Patients undergoingaortic aneurysm surgery face hemodynamic instability primarily due to threefactors: surgical trauma, blood loss, and a high burden of coronaryatherosclerosis. This elevates the risk of perioperative cardiovascularcomplications, necessitating cardiac monitoring. In major surgeries, hemodynamicsand cardiac function are typically monitored through clinical observations andcardiac biomarkers.  Myocardial injury ,often remains asymptomatic, and is associated with an almost 10-fold increasein short-term mortality11.