Reduced Right Ventricular Function Predicts Long-Term Cardiac Re-Hospitalization after Cardiac Surgery

Lella, Leela K.; Sales, Virna L.; Goldsmith, Yuliya B.; Chan, Jeremy; Iskandir, Marina; Gulkarov, Iosif; Tortólani, Anthony J.; Brener, Sorin J.; Sacchi, Terrence J.; Heitner, John F.

doi:10.1371/journal.pone.0132808

Cited by 31 publications

(21 citation statements)

References 32 publications

(40 reference statements)

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“…Regarding prevalence of RV dysfunction pre-operatively, we found that a large number of patients had RV dysfunction at time of surgery (38%). This prevalence is similar to that reported in the literature: for example, Lella et al showed that CMR-evidenced RV dysfunction occurred in 44% (48/109) among patients undergoing elective CABG and valve surgery [19]. Similarly, Haddad et al demonstrated echo-evidenced RV dysfunction to occur in 22% (11/50) patients undergoing aortic or mitral valve surgery [17].…”

Section: Discussionsupporting

confidence: 83%

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

Rong

Yum

Abouzeid

et al. 2019

Cardiovasc Ultrasound

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Background 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. Methods 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. Results 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 < 35%. All conventional RV functional indices including TAPSE, S′ and FAC declined immediately following CPB (1.5 ± 0.3 vs.1.1 ± 0.3 cm, 8.0 ± 2.1 vs. 6.2 ± 2.5 cm/s, 36.8 ± 9.3 vs. 29.3 ± 10.6%; p < 0.001 for all). However, left ventricular (LV) and RV hemodynamic parameters remained unchanged (LV ejection fraction (EF): 56.8 ± 13.0 vs. 55.8 ± 12.9%; p = 0.40, pulmonary artery systolic pressure (PASP): 26.5 ± 7.4 vs 27.3 ± 6.7 mmHg; p = 0.13). Speckle tracking echocardiographic data demonstrated a significant decline in RV global longitudinal strain (GLS) [19.0 ± 6.5 vs. 13.5 ± 6.9%, p < 0.001]. Pre-procedure FAC, GLS and free wall strain predicted RV dysfunction at chest closure (34.7 ± 9.1 vs. 41.6 ± 8.1%, p = 0.01, 17.7 ± 6.5 vs. 21.8 ± 5.4%; p = 0.03, 20.3 ± 6.4 vs. 24.2 ± 5.8%; p = 0.04), whereas traditional linear RV indices such as TAPSE and RV S′ at baseline had no impact on intraoperative RV dysfunction ( p = NS for both). Conclusions Global and regional RV function, as measured by 2D indices and strain, acutely decline intraoperatively. Impaired RV strain is associated with intraoperative RV functional decline and provides incremental value to traditional RV indices in predicting those who will develop RV dysfunction.

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Section: Discussionsupporting

confidence: 83%

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

Rong

Yum

Abouzeid

et al. 2019

Cardiovasc Ultrasound

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“…Patients undergoing major vascular surgery are at high risk for postoperative cardiac complications and perioperative morbidity and mortality. 14 In addition to the elevated surgical risk associated with major vascular procedures, the increased perioperative morbidity and mortality has been attributed to a higher prevalence of cardiac disease in the vascular patient population. 5 For example, congestive heart failure (CHF) is an important predictor for postoperative cardiac events in patients undergoing vascular surgery.…”

mentioning

confidence: 99%

Preexisting Right Ventricular Dysfunction Is Associated With Higher Postoperative Cardiac Complications and Longer Hospital Stay in High-Risk Patients Undergoing Nonemergent Major Vascular Surgery

Chou

Gylys

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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Objectives: To evaluate whether the presence of preexisting right ventricular (RV) dysfunction in high-risk patients undergoing non-emergent major vascular surgery is associated independently with higher incidents of postoperative cardiac complications and a longer length of hospital stay. Design: Retrospective chart review. Setting: Singlecenter university hospital setting. Participants: The patient population consisted of those identified as American Society of Anesthesiologists classification III and above who had a preoperative echocardiogram within 1 year of undergoing nonemergent major vascular surgery between January 2010 and May 2017. Measurements and Main Results: After multivariate analyses, RV dysfunction (RVD) is associated independently with a higher incidence of postoperative major cardiac complications with an odds ratio = 6.3 (95% confidence interval [CI], 1.038.5; p = 0.046). In addition, patients with RVD had a 50% longer length of stay than those without RVD (incident rate ratio [95% CI], 1.5 [1.21.8]; p < 0.001). Conclusion: In this retrospective study of high-risk patients undergoing major vascular surgery, RV dysfunction was associated independently with a higher incidence of postoperative major cardiovascular events and longer length of hospital stays. Based on current findings, the prognostic value of RVD extends beyond the cardiac surgical cohort. Knowledge in management of patients with RVD in the perioperative setting should be understood by all anesthesiologists. Of note, a future study with a larger sample size is needed to validate the current findings given the small sample size of this study.

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“…In addition to LV function improvement, right ventricular (RV) function also improves after CABG, especially in patients with low baseline RV ejection fraction 45 . Preoperative RV systolic dysfunction predicts long-term cardiac re-hospitalization and cardiovascular death 46,47 . Preoperative left atrial enlargement (left atrial diameter ≥ 4 cm) is a strong independent predictor of mortality after CABG 48 .…”

Section: Discussionmentioning

confidence: 99%

Clinical utility of early postoperative cardiac multidetector computed tomography after coronary artery bypass grafting

Kang

Lim

Park

et al. 2020

Sci Rep

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We evaluated the clinical utility of early postoperative cardiac computed tomography (ct) for evaluating left ventricular (LV) function and predicting prognosis in patients who had undergone coronary artery bypass grafting (CABG). Of the 205 patients who underwent CABG from March 2011 to December 2014, 136 underwent early postoperative cardiac CT (within 30 days after CABG) and were enrolled as the study population. The baseline and postoperative follow-up echocardiographic findings, major adverse cardiac events (MACE), and death were recorded for a follow-up period (mean, 5.9 ± 1.1 years). functional cardiac ct parameters were compared to echocardiographic measurements. the associations between cardiac CT findings and functional recovery and prognosis were evaluated by logistic regression analyses. The LVEF measured via cardiac CT was significantly higher (56.2 ± 11.5% vs. 61.9 ± 12.9%; p = 0.0002) compared to those via early postoperative echocardiography, but the wall motion score index (WMSI) was not significantly different (1.23 ± 0.33 vs. 1.21 ± 0.28, p = 0.5041) between the two methods. During the follow-up period, 17 patients (12.5%) died and 40 (29.4%) developed MACE. Both the LVEF and WMSI measured with early postoperative echocardiography (p = 0.0202 and odds ratio [OR] = 5.0171, p = 0.0039, respectively), and cardiac CT (OR = 0.9625, p = 0.0091 and OR = 14.3605, p = 0.0001, respectively) predicted MACE OR = 0.9630, but only the WMSI, measured using cardiac CT, predicted all-cause death (OR = 10.6017, p = 0.0035). In CABG patients, LVEF and the WMSI measured with early postoperative cardiac CT were comparable with echocardiography and predicted the development of MACE and all-cause death. Coronary artery bypass grafting (CABG) restores myocardial contractile function in patients with multi-vessel coronary artery disease 1,2 , but this is not always effective 3,4. Global ischemia and superimposed reperfusion injury might have deleterious effects on the heart 5-7. Moreover, the time course of functional recovery after CABG varies from immediately intra-operatively to 1 year postoperatively 7-11. Therefore, monitoring cardiac function in patients who have undergone CABG is important to predict their clinical outcome. Early anatomical recognition of bypass graft failure is important in terms of predicting clinical outcomes after CABG 12-15. Computed tomography (CT) is a powerful noninvasive technique providing anatomical information on graft patency, with simultaneous evaluation of cardiac function without any need for additional examination 16. Several studies have shown that CT is comparable to echocardiography and MRI for assessment of global left ventricular (LV) function and regional wall motion 17,18. Moreover, CT is quicker and easier to perform than MRI, which makes it suitable for the examination of patients who have recently undergone CABG.

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Reduced Right Ventricular Function Predicts Long-Term Cardiac Re-Hospitalization after Cardiac Surgery

Cited by 31 publications

References 32 publications

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

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

Preexisting Right Ventricular Dysfunction Is Associated With Higher Postoperative Cardiac Complications and Longer Hospital Stay in High-Risk Patients Undergoing Nonemergent Major Vascular Surgery

Clinical utility of early postoperative cardiac multidetector computed tomography after coronary artery bypass grafting

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