Journal Article

18 Effect of high-dose statin loading on global left ventricular stain parameters and cardiac biomarker release in patients undergoing valve replacement

Khanna, Rupali, Garg, Naveen, Tewari, Satyendra, Tewari, Prabhat, Agarwal, Surendra K, Prajapati, Sudesh, Kapoor, Aditya, Raut, Kamlesh, Kumar, Sudeep, Chandra, Bipin, Pande, Shantanu, Sahu, Ankit

2023

Overview

IntroductionData on pre-operative statin loading for patients undergoing valve replacement (VR) and its effects on global and regional strain are not well described. We studied the effect of rosuvastatin 40 mg in 50 patients of rheumatic valvular heart disease undergoing VR (34 MVR,11 DVR, 5 AVR) on speckle strain parameters and release kinetics of cardiac biomarkers. (TnI, CK-MB and BNP).MethodsPatients received a loading dose rosuvastatin (40 mg initiated 7 days before surgery; statin loaded group; SL) or no statins (non-loaded group, NL). TnI, CK-MB and BNP were measured at baseline and at 8, 24, and 48 hours postoperatively. 2D echocardiography for global LV (longitudinal, GLS, circumferential, GCS and radial, GRS) strain was done preoperatively, @ 48 hours and 30 days post surgery. Primary outcome was to assess the effect of high dose statin loading on global LV strain patterns.ResultsFollowing VR, there was decline in mean GLS, mean GCS and mean GRS at 48 hours in both SL and NL groups. At 48 hours, the mean GLS (-10.9 + 2.1% vs -10.2 + 2.0%), mean GCS (-10.8 + 2.1% vs -9.9 + 2.1%), and mean GRS (16.5 + 4.8% vs 15.9 + 4.6%) were comparable (although slightly higher) in the SL vs NL groups. However % decline in each strain was significantly lesser in SL groups (% change mean GLS 35.8 vs 38.8%, mean GCS 34.0% vs 44.1% and mean GRS 45.7% vs 52.6% respectively). At 30 days post surgery, there was an increase in all global LV strains (GLS, GCS, and GRS) in both the groups. Significantly higher improvement (vs 48 hour values) was noted in SL as compared to NL group for GLS (-15.9+2% vs -12.6+1.6%; p<0.01), GCS (-15.1+2.9% vs -13.0+2.4%; p<0.01) and GRS (22.1+6.8% vs 19.3+6.5%; p=0.03) at 30 days post surgery.All three cardiac biomarkers (Trop I, CKMB, NT pro BNP) increased significantly following surgery in both groups. For all three biomarkers, values remained consistently lower in the SL group vs NL group at 8, 24 and 48 hours. The mean delta troponin-I, the mean delta CKMB, mean delta NTPBNP (change from baseline to peak level) was significantly lower in the SL group (p<0.05). Mean hospital stay , mean ICU stay and mean ventilator duration were significantly shorter in the SL group. Pearson’s correlation test analysis revealed that baseline and 48 hours strain parameters significantly correlated with post-operative LVEF. Multivariate logistic regression analysis demonstrated that only baseline GCS and GLS at 48 hours were found to be independent for predicting postoperative LVEF. In the ROC analysis Baseline GLS <14% and 48 hr GLS <9.0% best predicted post operative 30 day LVEF < 50%ConclusionUse of a high dose of rosuvastatin prior to isolated valve replacement surgery may be “cardioprotective” in terms of favourable effect on the global strain parameters and release kinetics of different biomarkers. These parameters may also be used as prognostic predictors and optimal timing of operation in this patient population.Conflict of InterestNone declared

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD
• Subject: ACHD/valve disease/pericardial disease/cardiomyopathy / Biomarkers / longitudinal left ventricular strain / Statin / Statins / Surgery / Valve replacement