Abstract
Right ventricular (RV) dysfunction occurs following lung resection and is associated with post-operative complications and long-term functional morbidity. Accurate peri-operative assessment of RV function would have utility in this population. The difficulties of transthoracic echocardiographic (TTE) assessment of RV function may be compounded following lung resection surgery, and no parameters have been validated in this patient group. This study compares conventional TTE methods for assessing RV systolic function to a reference method in a lung resection population. Right ventricular index of myocardial performance (RIMP), fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE) and S′ wave velocity at the tricuspid annulus (S′), along with speckle tracked global and free wall longitudinal strain (RV-GPLS and RV-FWPLS respectively) are compared with RV ejection fraction obtained by cardiovascular magnetic resonance (RVEFCMR). Twenty-seven patients undergoing lung resection underwent contemporaneous CMR and TTE imaging; pre-operatively, on post-operative day two and at 2 months. Ability of each of the parameters to predict RV dysfunction (RVEFCMR <45%) was assessed using the area under the receiver operating characteristic curve (AUROCC). RIMP, FAC and S′ demonstrated no predictive value for poor RV function (AUROCC <0.61, P > 0.05). TAPSE performed marginally better with an AUROCC of 0.65 (P = 0.04). RV-GPLS and RV-FWPLS demonstrated good predictive ability with AUROCC’s of 0.74 and 0.76 respectively (P < 0.01 for both). This study demonstrates that the conventional TTE parameters of RV systolic function are inadequate following lung resection. Longitudinal strain performs better and offers some ability to determine poor RV function in this challenging population.
Highlights
Using cardiovascular magnetic resonance (CMR) imaging our group has demonstrated right ventricular (RV) dysfunction following lung resection (1)
The aim of this study is to assess the utility of Transthoracic echocardiography (TTE) methods of assessing RV systolic function in a cohort undergoing lung resection
RV volumes were determined by manual planimetry of short-axis images according to standard methods and the RV ejection fraction (RVEFCMR) calculated (8)
Summary
Using cardiovascular magnetic resonance (CMR) imaging our group has demonstrated right ventricular (RV) dysfunction following lung resection (1). RV dysfunction in this group is associated with peri-operative morbidity and decreased long-term functional capacity (2, 3, 4, 5). Reliable assessment of RV systolic function in the perioperative period would enable identification of patients developing RV dysfunction. This may allow targeted implementation of management strategies, ameliorating the burden of disease in this population. Despite being a reference method for assessment of the RV, CMR is not suitable for routine use in this patient group. CMR is not universally available, some patients are permanently excluded as a result of implantable devices, the requirement of transfer to isolated sites, and the need for breath holds to reduce respiratory artefact, mean it is not suitable in the acutely unwell post-operative patient. Transthoracic echocardiography (TTE) is the mainstay of assessment of RV structure and function in the majority of clinical settings
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