Right ventricular function after cardiac surgery: the diagnostic and prognostic role of echocardiography

Mandoli, Giulia Elena; Cameli, Matteo; Novo, Giuseppina; Agricola, Eustachio; Righini, Francesca Maria; Santoro, Ciro; D’Ascenzi, Flavio; Ancona, Francesco; Sorrentino, Regina; D’Andrea, Antonello; Galderisi, Maurizio; Mondillo, Sergio

doi:10.1007/s10741-019-09785-2

Cited by 44 publications

(38 citation statements)

References 80 publications

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“…Although we were able to obtain statistically significant results, they need to be confirmed in studies with a large number of patients. Finally, the definition of the RV function was based on the standard indexes of RV systolic and diastolic function without second level techniques (speckle-tracking RV measurement, 3D echocardiography), which have been used in recent years [26]. However, new technologies, such as global longitudinal strain (3%) and 3D echocardiography (1%), have rarely been used to quantify RV function in clinical practice [27].…”

Section: Discussionmentioning

confidence: 99%

Impaired right ventricular filling in patients with a chronic coronary syndrome

2021

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Aim: The prognostic value of right ventricle (RV) systolic dysfunction is known but the RV diastolic dysfunction (RVDD) is less investigated, thus the purpose of this study was to assess the incidence of RVDD in patients with coronary artery disease (CAD) and to identify factors associated with its presence. Material and methods: We examined 200 patients with stable CAD (153 men). RV diastolic parameters were studied by echocardiography: peak velocity of early (Et) and late (At) RV fill-ing and their ratio, velocities at the tricuspid annulus (et’, a’t, s’t). Patients were divided into 2 groups: with (n=92) and without RVDD (n=108). Results: Old myocardial infarction (MI) (p=0.007), anterior MI (p=0.001), congestive heart failure (p=0.030) and peripheral arterial disease (p=0.030) were more prevalent in patients with RVDD. The end-systolic dimensions were higher (p=0.010), while left ventricular (LV) ejection fraction (EF) (p=0.044) and the mitral E/A ratio (p<0.001) were lower in this group. No significant differences were found between the groups in the coronary artery stenosis. Independent predictors of the RVDD presence were increased age, old MI, hyperlipidemia, moderate chronic heart failure, peripheral arterial disease, and decreased LVEF. Conclusions: The RV diastolic dysfunction is much more common than systolic dysfunction in patients with stable CAD (46% and 7.5%, respectively). The RVDD presence was predominantly associated with an increase in age and LV systolic dysfunction, but not with coronary artery lesions. The predictive value of RVDD requires further research.

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Section: Discussionmentioning

confidence: 99%

Impaired right ventricular filling in patients with a chronic coronary syndrome

2021

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“…RV structure and function have an important prognostic value in several clinical settings, especially in chronic HF, representing the marker of transition to advanced HF and worse outcome. Furthermore, most patients undergoing cardiac surgery present a variable degree of reversible or irreversible reduction in RV function, which in turn was associated with lower post-operative survival [59]. Therefore, having an already impaired RV function at pre-operative assessment should in some way discourage aggressive therapies due to the higher risk of mortality for worsening RV failure.…”

Section: Right Ventricular Dysfunction: Too Late For Surgery?mentioning

confidence: 99%

Speckle tracking echocardiography in primary mitral regurgitation: should we reconsider the time for intervention?

et al. 2021

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Thanks to the improvement in mitral regurgitation (MR) diagnostic and therapeutic management, with the introduction of minimally invasive techniques which have considerably reduced the individual surgical risk, the optimization of the timing for MR “open” or percutaneous surgical treatment has become a main concern which has highly raised scientific interest. In fact, the current indications for intervention in MR, especially in asymptomatic patients, rely on echocardiographic criteria with high severity cut-offs that are fulfilled only when not only mitral valve apparatus but also the cardiac chambers’ structure and function are severely impaired, which results in poor benefits for post-operative clinical outcome. This led to the need of new indices to redefine the optimal surgical timing in these patients. Speckle tracking echocardiography provides early markers of cardiac dysfunction due to subtle myocardial impairment; therefore, it could offer pivotal information in this setting. In fact, left ventricular and left atrial strains have already shown evidence about their usefulness in recognizing MR impact not only on symptoms and quality of life but also on cardiovascular events and new-onset atrial fibrillation in these patients. Moreover, right ventricular strain could be used to identify those patients with advanced cardiac damage and different grades of right ventricular dysfunction, which entails higher risks for cardiac surgery that could overweigh surgical benefits. This review aims to describe the importance of reconsidering the timing of intervention in MR and to analyze the potential additive value of speckle tracking echocardiography in this clinical setting.

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“…The right ventricle is characterized by a complex geometry, therefore, its imaging assessment by echocardiography is challenging. It is divided in three main parts: the inflow tract, the apical portion and the outflow tract [2,3]. The physiology of RV contraction is quite elaborated too.…”

Section: Right Ventricular Anatomy and Its Role In Lung Diseasesmentioning

confidence: 99%