113: Prognostic value of right ventricular two-dimensional global strain after cardiac surgery

Abstract

To assess the prognostic value of right ventricular (RV) function by 2D global strain, RV fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE) in patients referred to cardiac surgery. The study included 344 patients (67±13 years, LVEF= 52%±12%) referred for left side cardiac surgery (121 isolated CABG, 146 aortic valve surgery, EuroSCORE 10.5%±13). RV function before cardiac surgery assessed by RV-2D global strain by speckle tracking (6-segments model), RVFAC and TAPSE was compared to postoperative outcome defined by one-month mortality. RV-2D global strain was feasible in 73% of patients (n=250), while RVFAC and TAPSE were computed in all. RV-2D global strain averaged - 18±5% and moderately correlated with RVFAC (r=-0.49, P<0.0001) and TAPSE (r=-0.42, P<0.0001). RV dysfunction was more observed by 2D-strain [61% (n=152) and 47% (n=118) for RV-2D global strain>-20% and >-18%, respectively] than by TAPSE<16 mm (14%) and RVFAC<35% (6%). Univariate analysis showed that RV-2D global strain (AUC=0.72, P<0.001), TAPSE (AUC=0.65, P=0.009) and RVFAC (AUC=0.63, P=0.02) were all predictive of postoperative mortality (n=26, 7.5%) but only RV-2D global strain remained associated with outcome (OR=1.1, P=0.03) by stepwise multivariate analysis adjusted to Euroscore. Importantly, in patients with RV dysfunction (RV-2D global strain>-18%), postoperative mortality was strongly reduced (7.5% vs. 24%, P=0.02) when cardiac pulmonary bypass duration was <2 hours. RV-2D global strain appears more sensitive and superior to conventional 2D echocardiography markers for characterizing RV dysfunction and predict postoperative outcome. In patients with impaired RV-2D global strain, postoperative mortality may be reduced by shortening cardiac pulmonary bypass duration.