Association Between Three-Dimensional Right Ventricular Ejection Fraction and In-Hospital Outcomes in Patients Undergoing Cardiac Surgery: A Multicenter Study.
Edith L Posada-Martinez, Juan B Ivey-Miranda, Xochitl A Ortiz-Leon, Jose A Arias-Godinez, Juan F Fritche-Salazar, Hugo G Rodriguez-Zanella, Maria E Ruiz Esparza-Dueñas, Diana Romero-Zertuche, Ivan I Silvestre-Flores, Julieta Morales-Portano, Arturo Orea-Tejeda, Jorge Rojas-Serrano, Robert L McNamara, Pedro A Reyes Lopez, Lissa Sugeng
Author Information
Edith L Posada-Martinez: Echocardiography Department, Instituto Nacional de Cardiología "Ignacio Chavez", Mexico City, Mexico.
Juan B Ivey-Miranda: Hospital de Cardiología Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Xochitl A Ortiz-Leon: Echocardiography Department, Instituto Nacional de Cardiología "Ignacio Chavez", Mexico City, Mexico.
Jose A Arias-Godinez: Echocardiography Department, Instituto Nacional de Cardiología "Ignacio Chavez", Mexico City, Mexico.
Juan F Fritche-Salazar: Echocardiography Department, Instituto Nacional de Cardiología "Ignacio Chavez", Mexico City, Mexico.
Hugo G Rodriguez-Zanella: Echocardiography Department, Instituto Nacional de Cardiología "Ignacio Chavez", Mexico City, Mexico.
Maria E Ruiz Esparza-Dueñas: Echocardiography Department, Instituto Nacional de Cardiología "Ignacio Chavez", Mexico City, Mexico.
Diana Romero-Zertuche: Hospital de Cardiología Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Ivan I Silvestre-Flores: Hospital de Cardiología Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Julieta Morales-Portano: Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico.
Arturo Orea-Tejeda: Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.
Jorge Rojas-Serrano: Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.
Robert L McNamara: Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut.
Pedro A Reyes Lopez: Echocardiography Department, Instituto Nacional de Cardiología "Ignacio Chavez", Mexico City, Mexico. Electronic address: maestriaydoctoradoinc@yahoo.com.mx.
Lissa Sugeng: Research Consultant for Yale Echo Corelab, Yale University, New Haven, Connecticut.
AIMS: Cardiac surgery is the cornerstone of treatment of several heart conditions, but accurate risk stratification is critical. Commonly used scores do not include right ventricular (RV) function. We aimed to evaluate whether three-dimensional (3D) RV ejection fraction (RVEF) predicts outcomes in patients undergoing cardiac surgery after adjusting for the EuroSCORE II. METHODS AND RESULTS: This is a prospective multicenter study of adult patients undergoing cardiac surgery at 3 centers. Right ventricular function parameters were analyzed with transesophageal echocardiogram before the surgery. We evaluated the association of 3D RVEF with the primary outcome (composite of in-hospital mortality or need of temporary ventricular assist device) after adjusting for the EuroSCORE II. Exploratory end points were time on mechanical ventilation and time on inotropes. We included 248 patients (median age, 69 years; 43% female). Sixty-nine percent had normal RVEF (≥45%). Right ventricular function parameters (tricuspid annular plane systolic excursion, fractional area change, and RV free-wall longitudinal strain) were lower in the group of decreased RVEF (P < .001 for all). The primary outcome occurred in 28 patients (11%). After adjusting for the EuroSCORE II, decreased RVEF was independently associated with the primary outcome (hazard ratio = 2.46; 95% CI, 1.10, 5.50; P = .028). Importantly, 3D RVEF was superior to all other parameters of RV systolic function to predict the primary outcome (P = .006). At 30 days, survival free of the primary end point was 72% ± 8% versus 93% ± 3% (P < .001) in decreased versus normal RVEF, respectively. Right ventricular ejection fraction was associated with shorter time on mechanical ventilation (r = -0.27, P < .001) and shorter time on inotropes (r = -0.20, P = .01). CONCLUSIONS: Among the RV function parameters, 3D RVEF is the strongest predictor of in-hospital mortality or need of temporary ventricular assist device in patients undergoing cardiac surgery. This multicenter study suggests that 3D RVEF should be included in the evaluation of patients undergoing surgery because it might improve stratification.
