Does high dose statin pretreatment affect global strains in patients undergoing valve replacement

Sudesh Prajapathi; Aditya Kapoor; Surendra Kumar Agarwal; Prabhat Tewari; Shantanu Pande; Bipin Chandra; Ankit Sahu; Roopali Khanna; Sudeep Kumar; Naveen Garg; Satyendra Tewari

doi:10.1007/s12055-023-01652-y

Does high dose statin pretreatment affect global strains in patients undergoing valve replacement

Indian J Thorac Cardiovasc Surg. 2024 May;40(3):300-310. doi: 10.1007/s12055-023-01652-y. Epub 2023 Dec 22.

Affiliations

¹ Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014 India.
² Cardiovascular and Thoracic Surgery, Sanjay Gandhi PGIMS, Lucknow, 226014 India.
³ Cardiac Anesthesia, Sanjay Gandhi PGIMS, Lucknow, 226014 India.

PMID: 38681712
PMCID: PMC11045680 (available on 2025-05-01)
DOI: 10.1007/s12055-023-01652-y

Abstract

Purpose: To study the effect of rosuvastatin 40 mg (initiated 7 days prior to surgery) in patients undergoing valve replacement (VR) for rheumatic mitral valve disease on left ventricular (LV) strain and biomarker release kinetics.

Methods: In this randomized study, cardiac biomarkers viz. troponin I (TnI), Creatine kinase MB (CK-MB), N-terminal pro B-type natriuretic peptide (NTPBNP) were measured before surgery; and 8, 24 and 48 h postoperatively. Global LV (circumferential, global circumferential strain (GCS); longitudinal, GLS; radial, global radial strain (GRS)) strains were measured preoperatively; and 48 h and 30 days postoperatively.

Results: Following VR, Global Longitudinal Strain (GLS), Global Circumferential Strain (GCS) and Global Radial Strain (GRS) declined at 48 h in both statin loaded (SL) and non loaded (NL) groups. The %decline in strain was significantly lower in SL group (% change in GLS 35.8% vs 38.8%, GCS 34% vs 44.1%, GRS 45.7% vs 52.6%; p < 0.001).All strain values improved at 30 days with higher improvement in SL group (GLS -15.92 ± 2.00% vs -12.6 ± 1.66%, GCS -15.12 ± 2.93% vs -13.04 ± 2.44%; GRS 22.12 ± 6.85% vs 19.32 ± 6.48%). While TnI, CKMB, NTPBNP increased following surgery, values at 8, 24 and 48 h were lower in the SL vs. NL group. Mean change (baseline to peak biomarker value) was also significantly lower in SL group.The SL group had shorter hospital and Intensive Care Unit (ICU) stay. On Receiver Operating Characteristic Curve (ROC) analysis, baseline GCS ≤ 14% best predicted postoperative 30 day Left Ventricular Ejection Fraction (LVEF) ≤ 50%.

Conclusion: Pre-operative high dose rosuvastatin was "cardioprotective" with favorable effect on LV global strain and release kinetics of biomarkers. These cut-offs (described for the first time for rheumatic VR) can be used as prognostic predictors.

Keywords: Biomarkers; Echocardiography; Global strain; Heart valve prosthesis implantation; Hydroxymethylglutaryl-CoA reductase inhibitors; Preoperative care.

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