Association of Three-Dimensional Mesh-Derived Right Ventricular Strain with Short-Term Outcomes in Patients Undergoing Cardiac Surgery

Keller, Marius; Heller, Tim; Duerr, Marcia-Marleen; Schlensak, Christian; Nowak-Machen, Martina; Feng, You-Shan; Rosenberger, Peter; Magunia, Harry

doi:10.1016/j.echo.2021.11.008

Cited by 12 publications

(16 citation statements)

References 35 publications

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“…The paradigm of disease-induced RV enlargement and dilation with increased EDVs has existed for decades. However, RVEDV showed no independent association with short-term outcomes in a previous investigation from our institution ( 20 ). Another possible phenotype of pathological RV remodeling could be reflected by altered regional EDVs in the absence of global enlargement, e.g., increased apical EDVs vs. decreased inlet EDVs.…”

Section: Discussioncontrasting

confidence: 68%

“…Reproducibility was further warranted by an identical definition of the segmental borders in all meshes, avoiding errors due to manual border determination. Overall, parameters of cardiac function acquired intraoperatively using novel 3D techniques were lower than conventional reference ranges, a phenomenon that has been discussed previously ( 20 ).…”

Section: Discussionmentioning

confidence: 54%

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Regional Right Ventricular Function Assessed by Intraoperative Three-Dimensional Echocardiography Is Associated With Short-Term Outcomes of Patients Undergoing Cardiac Surgery

Keller

Duerr

Heller

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe assessment of right ventricular (RV) function in patients undergoing elective cardiac surgery is paramount for providing optimal perioperative care. The role of regional RV function assessment employing sophisticated state-of-the-art cardiac imaging modalities has not been investigated in this cohort. Hence, this study investigated the association of 3D echocardiography-based regional RV volumetry with short-term outcomes.Materials and MethodsIn a retrospective single-center study, patients undergoing elective cardiac surgery were included if they underwent 3D transesophageal echocardiography prior to thoracotomy. A dedicated software quantified regional RV volumes of the inflow tract, apical body and RV outflow tract employing meshes derived from 3D speckle-tracking. Echocardiographic, clinical and laboratory data were entered into univariable and multivariable logistic regression analyses to determine association with the endpoint (in-hospital mortality or the need for extracorporeal circulatory support).ResultsOut of 357 included patients, 25 (7%) reached the endpoint. Inflow RV ejection fraction (RVEF, 32 ± 8% vs. 37 ± 11%, p = 0.01) and relative stroke volume (rel. SV) were significantly lower in patients who reached the endpoint (44 ± 8 vs. 48 ± 9%, p = 0.02), while the rel. SV of the apex was higher (38 ± 10% vs. 33 ± 8%, p = 0.01). Global left and right ventricular function including RVEF and left ventricular global longitudinal strain did not differ. In univariable logistic regression, tricuspid regurgitation grade ≥ 2 [odds ratio (OR) 4.24 (1.66–10.84), p < 0.01], inflow RVEF [OR 0.95 (0.92–0.99), p = 0.01], inflow rel. SV [OR 0.94 (0.90–0.99), p = 0.02], apex rel. SV [OR 1.07 (1.02–1.13), p < 0.01] and apex to inflow rel. SV ratio [OR 5.81 (1.90–17.77), p < 0.01] were significantly associated with the endpoint. In a multivariable model, only the presence of tricuspid regurgitation [OR 4.24 (1.66–10.84), p < 0.01] and apex to inflow rel. SV ratio [OR 6.55 (2.09–20.60), p < 0.001] were independently associated with the endpoint.ConclusionsRegional RV function is associated with short-term outcomes in patients undergoing elective cardiac surgery and might be helpful for optimizing risk stratification.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 54%

Regional Right Ventricular Function Assessed by Intraoperative Three-Dimensional Echocardiography Is Associated With Short-Term Outcomes of Patients Undergoing Cardiac Surgery

Keller

Duerr

Heller

et al. 2022

Front. Cardiovasc. Med.

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“…We reported normal values of RV 3D strains in healthy volunteers using the ReVISION software (8). Recently, RV 3D strains were shown to be associated with short-term outcomes in patients undergoing cardiac surgery (19). However, no studies have investigated whether RV 3D strains provide prognostic information in patients with cardiovascular disease.…”

Section: Previous Studiesmentioning

confidence: 99%

“…2 ), 47% (39-54%),19.5% (15.7-23.3%), 15.2% (12.1-18.4%), and 30.0% (24.2-35.4%), respectively. 3D LVEF had a significant correlation with 3D LVGLS (r = 0.92) and 3D RVEF (r = 0.64).…”

mentioning

confidence: 99%

Prognostic Value of Right Ventricular Strains Using Novel Three-Dimensional Analytical Software in Patients With Cardiac Disease

Kitano

Kovács

Nabeshima

et al. 2022

Front. Cardiovasc. Med.

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BackgroundRight ventricular (RV) three-dimensional (3D) strains can be measured using novel 3D RV analytical software (ReVISION). Our objective was to investigate the prognostic value of RV 3D strains.MethodsWe retrospectively selected patients who underwent both 3D echocardiography (3DE) and cardiac magnetic resonance from January 2014 to October 2020. 3DE datasets were analyzed with 3D speckle tracking software and the ReVISION software. The primary end point was a composite of cardiac events, including cardiac death, heart failure hospitalization, or ventricular tachyarrhythmia.Results341 patients were included in this analysis. During a median of 20 months of follow-up, 49 patients reached a composite of cardiac events. In univariate analysis, 3D RV ejection fraction (RVEF) and three 3D strain values [RV global circumferential strain (3D RVGCS), RV global longitudinal strain (3D RVGLS), and RV global area strain (3D RVGAS)] were significantly associated with cardiac death, ventricular tachyarrhythmia, or heart failure hospitalization (Hazard ratio: 0.88 to 0.93, p < 0.05). Multivariate analysis revealed that 3D RVEF, three 3D strain values were significantly associated with cardiac events after adjusting for age, chronic kidney disease, and left ventricular systolic/diastolic parameters. Kaplan-Meier survival curves showed that 3D RVEF of 45% and median values of 3D RVGCS, 3D RVGLS, and 3D RVGAS stratified a higher risk for survival rates. Classification and regression tree analysis, including 22 clinical and echocardiographic parameters, selected 3D RVEF (cut-off value: 34.5%) first, followed by diastolic blood pressure (cut-off value: 53 mmHg) and 3D RVGAS (cut-off value: 32.4%) for stratifying two high-risk group, one intermediate-risk group, and one low-risk group.ConclusionsRV 3D strain had an equivalent prognostic value compared with 3D RVEF. Combining these parameters with 3D RVEF may allow more detailed stratification of patient's prognosis in a wide array of cardiac diseases.

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“…< − 20%) unterschieden 15 . Bei kardiochirurgischen Patienten scheint die Bestimmung des (3-D) RV-Strain der FAC-Messung prognostisch überlegen zu sein 16 , 17 .…”

Section: Rechtsventrikuläre Funktionunclassified

Perioperative Echokardiografie der rechts- und linksventrikulären Funktion

Koeppen¹,

Keller²

2022

Anästhesiol Intensivmed Notfallmed Schmerzther

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ZusammenfassungDie Echokardiografie erlaubt eine präzise und minimalinvasive Charakterisierung der rechtsventrikulären (RV) und linksventrikulären (LV) Funktion chirurgischer Patientinnen und Patienten. Eine korrekte Handhabung und ein fundiertes Verständnis der Messungen sind unabdingbar für eine valide echokardiografische Untersuchung. Im folgenden Beitrag werden die gängigsten, aber auch einige neue Parameter der RV- und LV-Funktion vorgestellt.

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Association of Three-Dimensional Mesh-Derived Right Ventricular Strain with Short-Term Outcomes in Patients Undergoing Cardiac Surgery

Cited by 12 publications

References 35 publications

Regional Right Ventricular Function Assessed by Intraoperative Three-Dimensional Echocardiography Is Associated With Short-Term Outcomes of Patients Undergoing Cardiac Surgery

Regional Right Ventricular Function Assessed by Intraoperative Three-Dimensional Echocardiography Is Associated With Short-Term Outcomes of Patients Undergoing Cardiac Surgery

Prognostic Value of Right Ventricular Strains Using Novel Three-Dimensional Analytical Software in Patients With Cardiac Disease

Perioperative Echokardiografie der rechts- und linksventrikulären Funktion

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