BackgroundIntraoperative or post procedure right ventricular (RV) dysfunction confers a poor prognosis in the post-operative period. Conventional predictors for RV function are limited due the effect of cardiac surgery on traditional RV indices; novel echocardiographic techniques hold the promise to improve RV functional stratification.MethodsComprehensive echocardiographic data were collected prospectively during elective cardiac surgery. Tricuspid annular plane systolic excursion (TAPSE), peak RV systolic velocity (S), and RV fractional area change (FAC) were quantified on transesophageal echo (TEE). RV global and regional (septal and free wall) longitudinal strain was quantified using speckle-tracking echo in RV-focused views. Two intraoperative time points were used for comparison: pre-sternotomy (baseline) and after chest closure.ResultsThe population was comprised of 53 patients undergoing cardiac surgery [15.1% coronary artery bypass graft (CABG) only, 28.3% valve only, 50.9% combination (e.g. valve/CABG, valve/aortic graft) surgeries], among whom 38% had impaired RV function at baseline defined as RV FAC <35%. All conventional RV functional indices including TAPSE, S and FAC declined immediately following CPB (1.50.3 vs.1.1 +/- 0.3cm, 8.0 +/- 2.1 vs. 6.2 +/- 2.5cm/s, 36.8 +/- 9.3 vs. 29.3 +/- 10.6%; p<0.001 for all). However, left ventricular (LV) and RV hemodynamic parameters remained unchanged (LV ejection fraction (EF): 56.8 +/- 13.0 vs. 55.8 +/- 12.9%; p=0.40, pulmonary artery systolic pressure (PASP): 26.5 +/- 7.4 vs 27.3 +/- 6.7mmHg; p=0.13). Speckle tracking echocardiographic data demonstrated a significant decline in RV global longitudinal strain (GLS) [19.0 +/- 6.5 vs. 13.5 +/- 6.9%, p<0.001]. Pre-procedure FAC, GLS and free wall strain predicted RV dysfunction at chest closure (34.7 +/- 9.1 vs. 41.6 +/- 8.1%, p=0.01, 17.7 +/- 6.5 vs. 21.8 +/- 5.4%; p=0.03, 20.3 +/- 6.4 vs. 24.2 +/- 5.8%; p=0.04), whereas traditional linear RV indices such as TAPSE and RV S at baseline had no impact on intraoperative RV dysfunction (p=NS for both).Conclusions Global and regional RV function, as measured by 2D indices and strain, acutely decline intraoperatively. Impaired RV strain is associated with intraoperative RV functional decline and provides incremental value to traditional RV indices in predicting those who will develop RV dysfunction.

Echocardiographic predictors of intraoperative right ventricular dysfunction: A 2D and speckle tracking echocardiography study

PALUMBO, MARIA CHIARA;
2019-01-01

Abstract

BackgroundIntraoperative or post procedure right ventricular (RV) dysfunction confers a poor prognosis in the post-operative period. Conventional predictors for RV function are limited due the effect of cardiac surgery on traditional RV indices; novel echocardiographic techniques hold the promise to improve RV functional stratification.MethodsComprehensive echocardiographic data were collected prospectively during elective cardiac surgery. Tricuspid annular plane systolic excursion (TAPSE), peak RV systolic velocity (S), and RV fractional area change (FAC) were quantified on transesophageal echo (TEE). RV global and regional (septal and free wall) longitudinal strain was quantified using speckle-tracking echo in RV-focused views. Two intraoperative time points were used for comparison: pre-sternotomy (baseline) and after chest closure.ResultsThe population was comprised of 53 patients undergoing cardiac surgery [15.1% coronary artery bypass graft (CABG) only, 28.3% valve only, 50.9% combination (e.g. valve/CABG, valve/aortic graft) surgeries], among whom 38% had impaired RV function at baseline defined as RV FAC <35%. All conventional RV functional indices including TAPSE, S and FAC declined immediately following CPB (1.50.3 vs.1.1 +/- 0.3cm, 8.0 +/- 2.1 vs. 6.2 +/- 2.5cm/s, 36.8 +/- 9.3 vs. 29.3 +/- 10.6%; p<0.001 for all). However, left ventricular (LV) and RV hemodynamic parameters remained unchanged (LV ejection fraction (EF): 56.8 +/- 13.0 vs. 55.8 +/- 12.9%; p=0.40, pulmonary artery systolic pressure (PASP): 26.5 +/- 7.4 vs 27.3 +/- 6.7mmHg; p=0.13). Speckle tracking echocardiographic data demonstrated a significant decline in RV global longitudinal strain (GLS) [19.0 +/- 6.5 vs. 13.5 +/- 6.9%, p<0.001]. Pre-procedure FAC, GLS and free wall strain predicted RV dysfunction at chest closure (34.7 +/- 9.1 vs. 41.6 +/- 8.1%, p=0.01, 17.7 +/- 6.5 vs. 21.8 +/- 5.4%; p=0.03, 20.3 +/- 6.4 vs. 24.2 +/- 5.8%; p=0.04), whereas traditional linear RV indices such as TAPSE and RV S at baseline had no impact on intraoperative RV dysfunction (p=NS for both).Conclusions Global and regional RV function, as measured by 2D indices and strain, acutely decline intraoperatively. Impaired RV strain is associated with intraoperative RV functional decline and provides incremental value to traditional RV indices in predicting those who will develop RV dysfunction.
2019
2D speckle tracking; Cardiac surgery; Intraoperative transesophageal echocardiography; Right ventricular function
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11311/1121295
Citazioni
  • ???jsp.display-item.citation.pmc??? 5
  • Scopus 15
  • ???jsp.display-item.citation.isi??? 10
social impact