Right Ventricular Myocardial Performance Index Predicts Perioperative Mortality or Circulatory Failure in High-Risk Valvular Surgery

Haddad, François; Denault, André; Couture, Pierre; Cartier, Raymond; Pellerin, Michel; Lévesque, Sylvie; Lambert, Jean; Tardif, Jean‐Claude

doi:10.1016/j.echo.2007.02.017

Cited by 132 publications

(89 citation statements)

References 16 publications

(17 reference statements)

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“…found that RV MPI assessed by intraoperative transesophageal echocardiography was associated with a higher incidence of circulatory failure after aortic and mitral valve surgery 20. Maslow et al.…”

Section: Discussionmentioning

confidence: 99%

Risk Prediction in Aortic Valve Replacement: Incremental Value of the Preoperative Echocardiogram

Tan

Flynn

Chen‐Tournoux

et al. 2015

JAHA

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BackgroundRisk prediction is a critical step in patient selection for aortic valve replacement (AVR), yet existing risk scores incorporate very few echocardiographic parameters. We sought to evaluate the incremental predictive value of a complete echocardiogram to identify high‐risk surgical candidates before AVR.Methods and ResultsA cohort of patients with severe aortic stenosis undergoing surgical AVR with or without coronary bypass was assembled at 2 tertiary centers. Preoperative echocardiograms were reviewed by independent observers to quantify chamber size/function and valve function. Patient databases were queried to extract clinical data. The cohort consisted of 432 patients with a mean age of 73.5 years and 38.7% females. Multivariable logistic regression revealed 3 echocardiographic predictors of in‐hospital mortality or major morbidity: E/e’ ratio reflective of elevated left ventricular (LV) filling pressure; myocardial performance index reflective of right ventricular (RV) dysfunction; and small LV end‐diastolic cavity size. Addition of these echocardiographic parameters to the STS risk score led to an integrated discrimination improvement of 4.1% (P<0.0001). After a median follow‐up of 2 years, Cox regression revealed 5 echocardiographic predictors of all‐cause mortality: small LV end‐diastolic cavity size; LV mass index; mitral regurgitation grade; right atrial area index; and mean aortic gradient <40 mm Hg.ConclusionsEchocardiographic measures of LV diastolic dysfunction and RV performance add incremental value to the STS risk score and should be integrated in prediction when evaluating the risk of AVR. In addition, findings of small hypertrophied LV cavities and/or low mean aortic gradients confer a higher risk of 2‐year mortality.

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Section: Discussionmentioning

confidence: 99%

Risk Prediction in Aortic Valve Replacement: Incremental Value of the Preoperative Echocardiogram

Tan

Flynn

Chen‐Tournoux

et al. 2015

JAHA

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“…RV systolic dysfunction, however, is associated with decreased preoperative cardiac output and a greater requirement of inotropic support after valvular surgery. 55,56 Traditional teaching has been that the RV may sustain severe tricuspid regurgitation for a long time without adverse consequences. Recently, however, Messika-Zeitoun and colleagues 8 have demonstrated that flail tricuspid valve is associated with decreased survival and a high incidence of HF, atrial fibrillation, and need for valve replacement.…”

Section: Valvular Heart Diseasementioning

confidence: 99%

Right Ventricular Function in Cardiovascular Disease, Part II

et al. 2008

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R ight ventricular (RV) function may be impaired in pulmonary hypertension (PH), congenital heart disease (CHD), and coronary artery disease and in patients with left-sided heart failure (HF) or valvular heart disease. In recent years, many studies have demonstrated the prognostic value of RV function in cardiovascular disease. In the past, however, the importance of RV function has been underestimated. This perception originated from studies on openpericardium dog models and from the observation that patients may survive without a functional subpulmonary RV (Fontan procedure). In the 1940s, studies using openpericardium dog models showed that cauterization of the RV lateral wall did not result in a decrease in cardiac output or an increase in systemic venous pressure. 1-3 As was later demonstrated, the open-pericardium model did not take into account the complex nature of ventricular interaction. In 1982, Goldstein and colleagues 2 showed that RV myocardial infarction (RVMI) in a closed-chest dog model led to significant hemodynamic compromise. These findings were further supported by clinical studies demonstrating an increased risk of death, arrhythmia, and shock in patients with RVMI. 4 The study of the RV is a relatively young field. In 2006, the National Heart, Lung, and Blood Institute identified RV physiology as a priority in cardiovascular research. 5 The goal of this review is to present a clinical perspective on RV physiology and pathobiology. In the first article of the series, the anatomy, physiology, embryology, and assessment of the RV were discussed. In this second part, we discuss the pathophysiology, clinical importance, and management of RV failure.

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“…Haddad et al (Haddad et al, 2007) further assessed the value of RV function relative to other validated risk factors in open valvular heart surgery on 50 patients undergoing valvular surgery. Patients with RV myocardial performance index (RVMPI) < 50% (n=20) presented a significantly higher occurrence of circulatory failure (16/20 (80%) vs 6/30 (20%), p<0.0001) as well as a higher postoperative heart failure mortality (14/20 (74%) vs 3/30 (10%), p<0.0001).…”

Section: Experience At the Montreal Heart Institutementioning

confidence: 99%

A Pathophysiological Approach to Understanding Pulmonary Hypertension in Cardiac Surgery

Nguyen¹,

Deschamps²,

Perrault³

et al. 2012

Perioperative Considerations in Cardiac Surgery

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Right Ventricular Myocardial Performance Index Predicts Perioperative Mortality or Circulatory Failure in High-Risk Valvular Surgery

Cited by 132 publications

References 16 publications

Risk Prediction in Aortic Valve Replacement: Incremental Value of the Preoperative Echocardiogram

Risk Prediction in Aortic Valve Replacement: Incremental Value of the Preoperative Echocardiogram

Right Ventricular Function in Cardiovascular Disease, Part II

A Pathophysiological Approach to Understanding Pulmonary Hypertension in Cardiac Surgery

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