Perioperative Course of Three-Dimensional–Derived Right Ventricular Strain in Coronary Artery Bypass Surgery: A Prospective, Observational, Pilot Trial

Labus, Jakob; Winata, Johan; Schmidt, Torsten; Nicolai, Joachim; Tomko, Matus; Sveric, Kunislav; Wilbring, Manuel; Fassl, Jens

doi:10.1053/j.jvca.2021.01.026

Cited by 13 publications

(19 citation statements)

References 43 publications

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“…In another retrospective trial, Keller and colleagues showed differences in perioperative changes of 3D-RV FWS between mitral valve surgery, off-pump CABG (OPCAB), and in percutaneous mitral valve repair (PMVR) [71•]. Regarding our own published data [72], 3D-RV FWS seems not to differ significantly in awake, spontaneously breathing patients and in patients under general anesthesia and positive pressure ventilation with stable hemodynamics. It remained unchanged after sternotomy but deteriorated after on-pump coronary artery bypass surgery in our group of patients.…”

Section: Novel Echocardiographic Parametersmentioning

confidence: 85%

“…Therefore, echocardiographers should be cautious in extrapolating these measures validated by TTE studies to their TEE examinations. Global measures of RV function as RV FAC [39,40], 3D-RV EF [46], 2D-RV GLS [61,78], and 3D-RV FWS [72] assessed by TEE seem to correlate better with TTE assessment and may provide better agreement with validated reference values.…”

Section: Tte Versus Tee Assessmentmentioning

confidence: 93%

“…Having the opportunity to distinguish longitudinal, radial, and circumferential contraction [49,55] RV strain analysis allow to differentiate perioperative changes of RV function in different procedures. Although in its infancy, perioperative three-dimensional RV strain analysis offers many features to overcome the problems of two-dimensional strain assessment and may help in decision-making [71,72].…”

Section: Future Directionsmentioning

confidence: 99%

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Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

Labus

Uhlig

2021

Curr Anesthesiol Rep

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Purpose of Review This review aims to highlight the perioperative echocardiographic evaluation of right ventricular (RV) function with strengths and limitations of commonly used and evolving techniques. It explains the value of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) and describes the perioperative changes of RV function echocardiographers should be aware of. Recent Findings RV dysfunction is an entity with strong influence on outcome. However, its definition and assessment in the perioperative interval are not well-defined. Moreover, values assessed by TTE and TEE are not interchangeable; while some parameters seem to correlate well, others do not. Myocardial strain analysis and three-dimensional echocardiography may overcome the limitations of conventional echocardiographic measures and provide further insight into perioperative cardiac mechanics. Summary Echocardiography has become an essential part of modern anesthesiology in patients with RV dysfunction. It offers the opportunity to evaluate not only global but also regional RV function and distinguish alterations of RV contraction.

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Section: Novel Echocardiographic Parametersmentioning

confidence: 85%

Section: Tte Versus Tee Assessmentmentioning

confidence: 93%

Section: Future Directionsmentioning

confidence: 99%

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Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

Labus

Uhlig

2021

Curr Anesthesiol Rep

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“…The development of such dysfunction can be influenced by various perioperative factors—sternotomy, pericardial incision, and cardioplegia variants. A recent study showed that a decrease in the mechanical function of the right ventricle (as assessed using a three-dimensional-derived RV free-wall strain) does not occur during surgery (before and after sternotomy) but after isolated CABG with cardiopulmonary bypass [ 22 ]. However, a significant decrease in right ventricular longitudinal function (TAPSE and s’) was also noted after off-pump CABG [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

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

Sumin

Щеглова

Корок

et al. 2022

JCM

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Objective. Right ventricular (RV) dysfunction after coronary artery bypass grafting (CABG) is associated with increased mortality and morbidity. In previous studies, the parameters of RV systolic function were mainly assessed, while the dynamics of RV diastolic function after surgery was practically not studied. The aim of this study was to study the dynamics of indicators of systolic and diastolic RV function after CABG as well as to identify factors associated with their presence. Methods. The study included 160 patients who underwent CABG and 36 volunteers with no history of coronary artery disease (CAD) as a control group. Echocardiographic examination of patients was performed to assess systolic and diastolic RV dysfunction before surgery and 18 months after CABG. A level of s’t < 10 cm/sec or TAPSE < 16 mm was considered as a sign of existing RV systolic dysfunction. RV diastolic dysfunction was defined as an Et/At ratio < 0.8 or >2.1 and/or an Et/et’ ratio > 6. Results. In CAD patients 18 months after CABG, there was an increase in the frequency of the right ventricular systolic (from 7.5% to 30%, p < 0.001) and diastolic (from 41.8% to 57.5%, p < 0.001) dysfunction. An increase in TAPSE (p = 0.007), a decrease in e’t (p = 0.005), and the presence of RV systolic dysfunction before surgery (p = 0.023) was associated with a significant increase in the likelihood of detecting RV systolic dysfunction 18 months after CABG (χ2(3) = 17.4, p = 0.001). High values of At before surgery (p = 0.021) and old myocardial infarction (p = 0.023) were significantly associated with an increased likelihood of detection of RV diastolic dysfunction 18 months after CABG (χ2(2) = 10.78, p = 0.005). Conclusions. This study demonstrated that in CAD patients 18 months after CABG, there was an increase in the frequency of right ventricular systolic and diastolic dysfunction. We also established the initial clinical, echocardiographic parameters, and perioperative complications associated with the presence of these changes in the postoperative period. The clinical and prognostic significance of the presence of systolic and/or diastolic RV dysfunction in patients 18 months after CABG remains to be explored.

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“…Literature on the perioperative changes of RV mechanics following cardiac surgery is conflicting. While the effects presumably depend on the procedure, comorbidities and other perioperative variables (such as the use of CPB), most studies report a reduction of RV longitudinal function while global RV function is maintained (19,24,27,(31)(32)(33). However, systematic assessment of RV mechanics employing 3D echocardiography is only used in a limited number of these investigations, potentially underestimating the role of circumferential RV function.…”

Section: Rv Mechanics and Load-strain Relationships (Volume Or Area)mentioning

confidence: 99%

Right ventricular volume-strain loops using 3D echocardiography-derived mesh models: proof-of-concept application on patients undergoing different types of open-heart surgery

Keller¹,

Puhlmann²,

Heller³

et al. 2022

Quant Imaging Med Surg

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Background: Right ventricular (RV) function can be quantified by right heart catheterization-derived pressure-volume loops. While this technique is invasive, echocardiography-based volume-strain loops (VSLs) potentially reflect a non-invasive alternative. In this study, an approach to generate VSLs from volume and multidimensional strain data of 3D echocardiography-derived RV mesh models is evaluated with regard to feasibility and reproducibility.Methods: In a retrospective cohort study design, 3D intraoperative transesophageal echocardiograms of twenty-three patients undergoing aortic valve surgery (AVS) and eighteen patients undergoing off-pump coronary artery bypass (OPCAB) grafting were available prior to sternotomy and after sternal closure. RV meshes were generated using 3D speckle-tracking. Custom-made software quantified the meshes' volumes, global longitudinal (RV-GLS) and global circumferential strain (RV-GCS) for VSL generation. Linear regression of systolic VSLs yielded slopes, intercepts and systolic areas. Polynomial regression of two orders was used to analyze systolic-diastolic coupling at 10% increments of the RV end-diastolic volume (RVEDV).Reproducibility was analyzed by fourfold double-measurements of four datasets.Results: VSL calculation was feasible from all included 3D datasets. RV-GLS remained unaltered, but RV-GCS worsened in AVS [abs. diff. (∆) 3.9%, P<0.01] and OPCAB patients (∆4.5%, P<0.001). While RV-GCS systolic areas were markedly reduced at the end of AVS (∆268mL%, P<0.01) and OPCAB (∆185mL%, P<0.001), RV-GCS slopes did not change. Systolic-diastolic uncoupling was not observed, but in trend, decreased diastolic RV-GCS after AVS (P=0.06) and increased diastolic RV-GCS after OPCAB (P=0.06) were observed. Intraclass correlation coefficients (0.84-0.98) and coefficients of variation (6.4-11.8%) indicated good reproducibility.Conclusions: RV VSL generation using 3D echocardiography-derived mesh models is feasible.Longitudinal and circumferential strain vectors yield intrinsically different VSL indices. In future investigations, VSLs of multidimensional strains could provide further insight into periprocedural changes of RV mechanics.

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Perioperative Course of Three-Dimensional–Derived Right Ventricular Strain in Coronary Artery Bypass Surgery: A Prospective, Observational, Pilot Trial

Cited by 13 publications

References 43 publications

Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

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

Right ventricular volume-strain loops using 3D echocardiography-derived mesh models: proof-of-concept application on patients undergoing different types of open-heart surgery

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