Is right ventricular systolic function reduced after cardiac surgery? A two- and three-dimensional echocardiographic study

Tamborini, Gloria; Muratori, Manuela; Brusoni, Denise; Celeste, Fabrizio; Maffessanti, Francesco; Caiani, Enrico G.; Alamanni, Francesco; Pepi, Mauro

doi:10.1093/ejechocard/jep015

Cited by 210 publications

(152 citation statements)

References 23 publications

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“…These two measures proved to be complementary-RV FAC identified a small group of patients (5%) with overt RV hypokinesis who were at extreme risk (50% observed mortality or major morbidity), whereas RV MPI identified a larger group (24%) with subclinical RV impairment which may not otherwise be detected by visual assessment of the RV that were at high risk (26% observed mortality or major morbidity). We opted not to include measures of longitudinal RV function (tricuspid annular plane systolic excursion or tricuspid annular tissue Doppler velocity) for 2 reasons: first, these have been shown to inaccurately correlate with postoperative RV ejection fraction 29 or functional capacity 30 after cardiac surgery, and second, these require dedicated M-Mode and tissue Doppler acquisitions, which are not always available. RV FAC and MPI have the distinct advantage of being measurable offline from routinely acquired images within <5 minutes.…”

Section: Discussionmentioning

confidence: 99%

Incremental Value of the Preoperative Echocardiogram to Predict Mortality and Major Morbidity in Coronary Artery Bypass Surgery

et al. 2013

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Background— Although echocardiography is commonly performed before coronary artery bypass surgery, there has yet to be a study examining the incremental prognostic value of a complete echocardiogram. Methods and Results— Patients undergoing isolated coronary artery bypass surgery at 2 hospitals were divided into derivation and validation cohorts. A panel of quantitative echocardiographic parameters was measured. Clinical variables were extracted from the Society of Thoracic Surgeons database. The primary outcome was in-hospital mortality or major morbidity, and the secondary outcome was long-term all-cause mortality. The derivation cohort consisted of 667 patients with a mean age of 67.2±11.1 years and 22.8% females. The following echocardiographic parameters were found to be optimal predictors of mortality or major morbidity: severe diastolic dysfunction, as evidenced by restrictive filling (odds ratio, 2.96; 95% confidence interval, 1.59-5.49), right ventricular dysfunction, as evidenced by fractional area change <35% (odds ratio, 3.03; 95% confidence interval, 1.28-7.20), or myocardial performance index >0.40 (odds ratio, 1.89; 95% confidence interval, 1.13-3.15). These results were confirmed in the validation cohort of 187 patients. When added to the Society of Thoracic Surgeons risk score, the echocardiographic parameters resulted in a net improvement in model discrimination and reclassification with a change in c-statistic from 0.68 to 0.73 and an integrated discrimination improvement of 5.9% (95% confidence interval, 2.8%-8.9%). In the Cox proportional hazards model, right ventricular dysfunction and pulmonary hypertension were independently predictive of mortality over 3.2 years of follow-up. Conclusions— Preoperative echocardiography, in particular right ventricular dysfunction and restrictive left ventricular filling, provides incremental prognostic value in identifying patients at higher risk of mortality or major morbidity after coronary artery bypass surgery.

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Section: Discussionmentioning

confidence: 99%

Incremental Value of the Preoperative Echocardiogram to Predict Mortality and Major Morbidity in Coronary Artery Bypass Surgery

et al. 2013

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“…On the other hand, RV performance may be preserved despite reduced TAPSE, as is frequently observed after cardiac surgery [20,21].…”

Section: Tricuspid Annular Plane Systolic Excursionmentioning

confidence: 99%

“…TAPSE, S') no longer reflect global RV performance because of geometrical (decreased longitudinal and increased transverse shortening) rather than functional alterations in the RV in the post-operative period. Diminished RV function, assessed by the reduction in TAPSE and S', may potentially be related to septal damage during cardiac surgical procedures, as well as poor RV protection during cardiopulmonary bypass, intraoperative ischemia and post-operative adherence of the RV to the thoracic wall [20,21].…”

Section: Wwwcardiologyjournalorgmentioning

confidence: 99%

Echocardiographic evaluation of right ventricular systolic function: The traditional and innovative approach

Smolarek¹,

Gruchała

Sobiczewski

2017

Cardiol J.

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Estimation of right ventricular (RV) performance still remains technically challenging due to its anatomical and functional distinctiveness. The current guidelines for the echocardiographic quantification of RV function recommend using multiple indices to describe the RV in a thorough and comprehensive manner, such as RV index of myocardial performance, tricuspid annular plane systolic excursion, fractional area change, Doppler tissue imaging-derived tricuspid lateral annular systolic velocity (S'-wave), three-dimensional RV ejection fraction (3D RVEF), RV longitudinal strain (RVLS)/strain rate by speckle-tracking echocardiography (STE). Among these, the last one mentioned here is an innovative and a particularly promising tool that yields more precise information about complex regional and global RV mechanics. STE was initially designed to evaluate left ventricular function, but recently it has been intro-duced to assess RV performance, which is difficult due to its unique structure and physiology. Many studies have shown that both free wall and 6-segment RVLS present a stronger correlation with the RVEF assessed by cardiac magnetic resonance than conventional parameters and seem to be more sensitive in detecting myocardial dysfunction at an earlier, subclinical stage. (Cardiol J 2017; 24, 5: 563-572)

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“…A komplikációmentes beavatkozások esetén a tartósan csökkent és lassú javulást mutató TAPSE-érték általános jelenség megtartott jobb kamrai ejekciós frakció mellett [41]. Ez a klinikai kép egyéb szívsebészeti beavatkozásoknál is jelen van, és feltehetően multifaktoriális eredetű [42]. A jobb kamrai longitudinális funkció csökkenése megtartott kamrafunkció mellett speckle-tracking analízissel is észlelhető [43].…”

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A jobb kamrai anatómia és funkció korszerű echokardiográfiás vizsgálata: patológiás és fiziológiás eltérések

et al. 2016

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A jobb kamra geometriai és funkcionális változásai számos megbetegedésben nagy jelentőséggel bírnak. Mindazonáltal a rutin echokardiográfiás mérések csak korlátozott diagnosztikus és prognosztikus erővel rendelkeznek. Az olyan modern szívultrahangos technikák, mint a speckle-tracking analízis vagy a 3D echokardiográfia napjainkban már elérhető és könnyen kivitelezhető módszerek, amelyek a jobb kamra komplex felépítésének és működésének költségha-tékony, noninvazív vizsgálatát teszik lehetővé. Diagnosztikus értékük és precizitásuk jóval nehezebben hozzáférhető eljárásokat helyettesíthet. Egyre bővülő irodalmi adatok alapján használatuk a mindennapi klinikumban (jobb kamrai infarktus, pulmonalis hypertensio, arrhythmogen jobb kamrai dysplasia, szívtranszplantáció utáni követés, a sportszív differenciáldiagnosztikája) lényeges segítséget jelenthet. Orv. Hetil., 2016, 157(29), 1139-1146. Kulcsszavak: 3D echokardiográfia, jobb kamra, jobbkamra-funkció Assessment of the right ventricular anatomy and function by advanced echocardiography: pathological and physiological insightsAccurate assessment of right ventricular geometry and function is of high clinical importance. However, several limitations have to be taken into consideration if using conventional echocardiographic parameters. Advanced echocardiographic techniques, such as speckle-tracking analysis or 3D echocardiography are reliable and simple tools providing a cost-effective and non-invasive alternative of current modalities used to characterize the right ventricle. There is a growing interest in the diagnostic and prognostic value of these methods regarding pathological (right ventricular infarction, pulmonary hypertension, arrhythmogenic right ventricular dysplasia, follow-up of heart transplantation) and even physiological (athlete's heart) alterations of the right ventricle. Keywords: 3D echocardiography, right ventricle, right ventricular functionLakatos, B., Kovács, A., Tokodi, M., Doronina, A., Merkely, B. [Assessment of the right ventricular anatomy and function by advanced echocardiography: pathological and physiological insights]. Orv. Hetil., 2016, 157(29), 1139-1146. ÖSSZEFOGLALÓ KÖZLEMÉNYRövidítések ARVD = arrhythmogen jobb kamrai dysplasia; CX = bal koszorúér körbefutó ága; EF = ejekciós frakció; FAC = frakcionális területváltozás; HTX = szívtranszplantáció; LAD = bal koszorúér elülső leszálló ága; MRI = mágneses rezonanciás képalko-tás; PET-CT = pozitronemissziós tomográfia-komputertomográfia fúziós képalkotás; PHT = pulmonalis hypertensio; RCA = jobb koszorúér; TAPSE = tricuspid annular plane systolic excursion A jobbkamra-funkció és annak változásai hosszú időn át mérsékelt figyelmet kaptak tudományos szempontból, annak ellenére, hogy már Sir William Harvey 1628-as "De Motu Cordis" című értekezésében is lényeges szerepet tulajdonít a jobb szívfélnek. Mint a szisztémás keringés motorja, a bal kamra volt a vizsgálatok fő tárgya: a kezdeti eredmények alapján a jobb kamra szabad falának kísérletes roncsolása nem járt érdemleges funkcionális

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Is right ventricular systolic function reduced after cardiac surgery? A two- and three-dimensional echocardiographic study

Cited by 210 publications

References 23 publications

Incremental Value of the Preoperative Echocardiogram to Predict Mortality and Major Morbidity in Coronary Artery Bypass Surgery

Incremental Value of the Preoperative Echocardiogram to Predict Mortality and Major Morbidity in Coronary Artery Bypass Surgery

Echocardiographic evaluation of right ventricular systolic function: The traditional and innovative approach

A jobb kamrai anatómia és funkció korszerű echokardiográfiás vizsgálata: patológiás és fiziológiás eltérések

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