Prognostic Value of Preoperative 2-Dimensional Left Ventricular, Right Ventricular, and Left Atrial Strain in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting: A Prospective Observational Study.

Objectives

To determine whether preoperative speckle-tracking strain of the left ventricle, right ventricle, and left atrium predicts new-onset postoperative atrial fibrillation (POAF) and other adverse outcomes after off-pump coronary artery bypass grafting (OPCAB).

Design

Prospective, single-center, observational, prognostic cohort study.

Setting

Tertiary-care university cardiac surgical center in western India.

Participants

One hundred fifty consecutive adults undergoing elective isolated OPCAB (January 2024-March 2025).

Interventions

None.

Measurements

AND MAIN

Results

Transthoracic echocardiography with offline speckle tracking was performed within 24 hours before surgery; left ventricular (LV) global longitudinal strain (GLS), right ventricular free-wall longitudinal strain (RVFWLS) and left atrial (LA) reservoir strain (peak atrial longitudinal strain [PALS]) were measured. POAF occurred in 62 of 150 patients (41.3%). Patients with POAF had less negative LV GLS (-16.07% v -17.85%), less negative RVFWLS (-21.85% v -24.47%), lower PALS (32.45% v 38.31%), and larger LA volume index (LAVI) (43.71 mL/m² v 33.01 mL/m²) (all p < 0.001). LAVI showed the highest discrimination (area under the curve [AUC], 0.867), followed by RVFWLS (AUC, 0.771), LV GLS (AUC, 0.766), and PALS (AUC, 0.765); LV ejection fraction did not discriminate (AUC, 0.541). After adjustment for age, European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, and LAVI, RVFWLS (adjusted odds ratio, 1.436; p = 0.008) and PALS (1.118 per 1% decrement, p = 0.039) were the only strain parameters that remained independent predictors, together with LAVI and age. RVFWLS was also independently associated with prolonged inotropic support beyond 48 hours.

Conclusions

Preoperative strain of the left ventricle, right ventricle, and left atrium carries prognostic information for POAF after OPCAB, but only RVFWLS and LA reservoir strain were independent strain predictors after adjustment; these parameters may identify a high-risk subgroup warranting intensified rhythm monitoring and prophylaxis. These associations do not establish causation.