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

• Published in: Cardiovascular ultrasound 2019-06, Vol.17 (1), p.11-11, Article 11
• Main Authors: Rong, Lisa Q, Yum, Brian, Abouzeid, Christiane, Palumbo, Maria Chiara, Brouwer, Lillian R, Devereux, Richard B, Girardi, Leonard N, Weinsaft, Jonathan W, Gaudino, Mario, Kim, Jiwon
• Format: Article
• Language: English
• Subjects: 2D speckle tracking; Aged; Aorta; Blood pressure; Bypass; Cardiac surgery; Cardiac Surgical Procedures; Cardiovascular disease; Chest; Coronary artery; Coronary vessels; Echocardiography; Echocardiography, Three-Dimensional - methods; Echocardiography, Transesophageal - methods; Elective Surgical Procedures; Esophagus; Female; Heart; Heart failure; Heart surgery; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Hemodynamics; Humans; Hypertension; Intraoperative Period; Intraoperative transesophageal echocardiography; Male; Middle Aged; Mortality; Population; Postoperative Complications; Predictive Value of Tests; Prospective Studies; Pulmonary artery; Right ventricular function; Stroke Volume - physiology; Surgery; Systole; Systolic pressure; Tracking; Ventricle; Ventricular Dysfunction, Right - diagnosis; Ventricular Dysfunction, Right - etiology; Ventricular Dysfunction, Right - physiopathology; Ventricular Function, Right - physiology
• ISSN: 1476-7120; 1476-7120
• DOI: 10.1186/s12947-019-0161-3

Intraoperative 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. Comprehensive 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. The 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