Clinically inapparent right heart dysfunction is associated with reduced myofilament force development in coronary artery disease

Abstract

Background Right ventricular dysfunction after CABG is associated with poor peri- and postoperative outcomes. We aimed to identify clinical and experimental predictors for preoperative inapparent right ventricular dysfunction and therefore hypothesized that reduced myofilament force development as well as altered levels of biomarkers might predict inapparent right ventricular dysfunction. Methods From 08/2016 to 02/2018, 218 patients scheduled for CABG were divided into two groups (TAPSE ≥ 20 mm, n = 178; TAPSE < 20 mm, n = 40). Baseline serum samples for biomarkers (Galectin, TGFß1, N Acyl-SDMA, Arginine, ADMA and Pentraxin-3), clinical laboratory and transthoracic echocardiographic parameters were evaluated. To examine the myocardial apparatus of the right ventricle intraoperative right auricular tissue was harvested for stepwise skinned fiber force measurements. Results Patients with TAPSE < 20 mm had a higher incidence of DM (55 vs. 34%, p = 0.018), preoperative AFib (43 vs. 16%, p < 0.001), reduced GFR (67 ± 18 vs. 77 ± 24 ml/min/1.73 m2, p = 0.013), larger LA area (22 ± 6 vs. 20 ± 5 cm2, p = 0.005) and reduced LVEF (50 vs. 55%, p = 0.008). Furthermore, higher serum ADMA (0.70 ± 0.13 vs. 0.65 ± 0.15 µmol/l, p = 0.046) and higher serum Pentraxin-3 levels (3371 ± 1068 vs. 2681 ± 1353 pg/dl, p = 0.004) were observed in these patients. Skinned fiber force measurements showed significant lower values at almost every step of calcium concentration (pCa 4.52 to pCa 5.5, p < 0.01 and pCa 5.75–6.0, p < 0.05). Multivariable analysis revealed DM (OR 2.53, CI 1.12–5.73, Euro Score II (OR 1.34, CI 1.02–1.78), preoperative AF (OR 4.86, CI 2.06–11.47), GFR (OR 7.72, CI 1.87–31.96), albumin (OR 1.56, CI 0.52–2.60), Pentraxin-3 (OR 19.68, CI 14.13–25.24), depressed LVEF (OR 8.61, CI 6.37–10.86), lower force values: (pCa 5.4; OR 2.34, CI 0.40–4.29 and pCa 5.2; OR 2.00, CI 0.39–3.60) as predictors for clinical inapparent right heart dysfunction. Conclusions These preliminary data showed that inapparent right heart dysfunction in CAD is already associated with reduced force development of the contractile apparatus.

Indicators of the Right Ventricle Systolic and Diastolic Function 18 Months after Coronary Bypass Surgery

“…In addition, after thoracic surgery, there were no changes in diastolic or systolic RV function, which were observed after heart surgery with pericardiotomy [ 24 ]. In patients with a mild reduced preoperative RV systolic function, a significant impairment of the contractile apparatus was observed when it was assessed using an experimental model of right atrial fibers [ 25 ]. Therefore, it is not surprising that this disturbance increased in the postoperative period.…”

“…Previous studies have shown that in patients with CAD before CABG, predictors of mild RV systolic dysfunction, in addition to low LV ejection fraction [ 25 , 26 ], were also carbohydrate metabolism disorders, arrhythmias, an increased risk of surgery according to the EuroScore II scale, as well as a decrease in kidney function [ 25 ]. At the same time, the localization and number of coronary stenoses and the localization of a previous myocardial infarction did not affect the frequency of detection of the right heart dysfunction [ 26 ].…”

“…A decrease in preoperative diastolic RV function is one of the independent risk factors for early death after CABG in patients with severe left ventricular dysfunction [ 28 ]. In addition, even though mild reduced right heart function (TAPSE in the normal range but less than 20 mm) had no impact on 30 day clinical outcome parameters, it was associated with a significantly longer hospital stay [ 25 ]. Moreover, in patients with baseline normal RV systolic function, the presence of RV diastolic dysfunction is associated with a higher incidence of postoperative heart failure requiring prolonged inotropic therapy [ 16 ].…”

The completeness of the left atrial appendage amputation during routine cardiac surgery

“…The reason is that the resection of the LAA is part of SEIDC trial performed in our institution with prospective patient inclusion and all the surgeons followed this protocol. We analysed the patients enrolled in trial regarding the clinical aspects and consequences of LAA amputation [ 11 – 13 ]. The study was approved by the University Hospital ethics committee (IRB approval: 143/17-sc 6.10.2017).…”