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Preoperative right ventricular dysfunction is a strong predictor of 3 years survival after cardiac surgery

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Abstract

Background

Prognostic value of right ventricular (RV) systolic function is well established in valvular disease, heart failure but has not been evaluated in patients undergoing cardiac surgery.

Objectives

The aim of the present study was to evaluate the prognostic value of preoperative RV dysfunction extensively evaluated on the basis of a large set of echocardiographic parameters [S′, RV fractional area change (RVFAC), right myocardial performance index (RMPI), isovolumic acceleration (IVA), RV dP/dt and basal longitudinal strain (BLS)] in a large population of unselected patient awaiting cardiac surgery.

Methods

We prospectively studied 400 consecutive patients referred for cardiac surgery, in a single surgical center. Echocardiography was performed 24 h before surgery and phone interview assessed the survival status (overall and cardiovascular death) 3-years after surgery.

Results

Among 400 patients, 271 were male, mean age was 70.3 ± 10.2. At 3-years the overall and cardiovascular mortality was, respectively, 10.5 and 6.8%. The univariate Cox analysis identified all RV function parameters excepted BLS as predictive factors of overall mortality, with the strongest value for RVFAC < 35% (HR 4.8), S′ < 10 cm/s (HR 3.8) and IVA < 1.8 m/s2 (HR 3.2) (all P < 0.001). All parameters were associated to cardiovascular mortality. In multivariate analysis, RVFAC, S′, dP/dt and IVA were significantly associated to 3-years overall mortality whatever the EuroSCORE. Abnormal RVFAC, S′, IVA and BLS were associated to cardiovascular mortality.

Conclusions

The presence of RV dysfunction before cardiac surgery assessed by echo significantly predicts postoperative mortality, and this is true whatever the EuroSCORE level. This result demonstrates the need of adding the assessment of echographic RV function before cardiac surgery.

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Abbreviations

CI:

Confidence interval

CMR:

Cardiac magnetic resonance imaging

GLS:

Global longitudinal strain

HR:

Estimated hazard ratios

IVA:

Isovolumic acceleration

IVRT:

Isovolumic relaxation time

LVEF:

Left ventricular ejection fraction

PVR:

Pulmonary vascular resistance

RMPI:

Right myocardial performance index

RV:

Right ventricle

RVEF:

Right ventricular ejection fraction

RVFAC:

Right ventricular fractional area change

S′:

Doppler-derived tricuspid lateral annular systolic velocity

SD:

Standard deviation

sPAP:

Systolic pulmonary artery pressure

TAPSE:

Tricuspid annular plane systolic excursion

TDI:

Tissue Doppler imaging

TR:

Tricuspid regurgitation

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Correspondence to Eric Abergel.

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On behalf of all authors, the corresponding author Eric Abergel states that there is no conflict of interest.

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Peyrou, J., Chauvel, C., Pathak, A. et al. Preoperative right ventricular dysfunction is a strong predictor of 3 years survival after cardiac surgery. Clin Res Cardiol 106, 734–742 (2017). https://doi.org/10.1007/s00392-017-1117-y

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  • DOI: https://doi.org/10.1007/s00392-017-1117-y

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