Francesco Ancona, Matteo Bellettini, Giovanni Polizzi, Gabriele Paci, Davide Margonato, Giacomo Ingallina, Stefano Stella, Giorgio Fiore, Annamaria Tavernese, Martina Belli, Federico Biondi, Alessandro Castiglioni, Paolo Denti, Nicola Buzzatti, Gaetano Maria De Ferrari, Ottavio Alfieri, Elisabetta Lapenna, Michele De Bonis, Francesco Maisano, Eustachio Agricola
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Exclusion criteria were previous TV surgery, urgent surgery, complex congenital heart disease, active endocarditis and inadequate acoustic window. Baseline clinical data were included, as well as laboratory tests and clinical risk score, as TRI-SCORE and MELD-XI. The clinical outcome was peri-operative mortality, defined as all-cause mortality within 30 days.</p><p><strong>Results: </strong>The final cohort included 79 patients. The end-point occurred in 7 patients (9%), who died within 30 days after isolated TV surgery. Receiver operator characteristic curves analysis showed that, among parameters of right ventricular function, right ventricular free wall longitudinal strain was the best parameter to predict peri-operative mortality (AUC: 0.854, 95% CI 0.74-0.96, P = 0.005, sensitivity 68%, specificity 100%). At univariable analysis, left ventricular ejection fraction, diabetes mellitus, creatinine, estimated glomerular filtration rate, serum sodium, MELD-XI, TRI-SCORE, right ventricular areas, right ventricular global longitudinal strain, right ventricular free wall longitudinal strain, fractional area change and the ratio between right ventricular free wall longitudinal strain/pulmonary arterial systolic pressure were significantly associated with the end-point. The combination of TRI-SCORE and right ventricular Strain, evaluating right ventricular systolic function with speckle-tracking echocardiography, outperformed classic TRI-SCORE in outcome prediction (AUC 0.874 vs 0.787, P = 0.05).</p><p><strong>Conclusions: </strong>Right ventricular free wall longitudinal strain has an incremental prognostic value over conventional parameters and significantly improves the ability of clinical scores to predict peri-operative mortality in patients undergoing isolated TV surgery.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580679/pdf/","citationCount":"0","resultStr":"{\"title\":\"Short-term outcome after isolated tricuspid valve surgery: prognostic role of right ventricular strain.\",\"authors\":\"Francesco Ancona, Matteo Bellettini, Giovanni Polizzi, Gabriele Paci, Davide Margonato, Giacomo Ingallina, Stefano Stella, Giorgio Fiore, Annamaria Tavernese, Martina Belli, Federico Biondi, Alessandro Castiglioni, Paolo Denti, Nicola Buzzatti, Gaetano Maria De Ferrari, Ottavio Alfieri, Elisabetta Lapenna, Michele De Bonis, Francesco Maisano, Eustachio Agricola\",\"doi\":\"10.1093/ejcts/ezae405\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To assess the incremental prognostic value of right ventricular free wall longitudinal strain over conventional risk scores in predicting the peri-operative mortality in patients with severe tricuspid regurgitation (TR) undergoing isolated tricuspid valve (TV) surgery.</p><p><strong>Methods: </strong>We retrospectively enrolled 110 consecutive patients with severe TR who underwent isolated TV surgery between November 2016 and July 2022 at San Raffaele Hospital, Milan, Italy. 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引用次数: 0
摘要
目的评估在预测接受孤立三尖瓣（TV）手术的重度三尖瓣反流（TR）患者围手术期死亡率时，右室游离壁纵向应变相对于传统风险评分的增量预后价值：我们回顾性纳入了2016年11月至2022年7月期间在意大利米兰圣拉斐尔医院接受孤立TV手术的110名连续重度TR患者。排除标准为既往接受过TV手术、紧急手术、复杂先天性心脏病、活动性心内膜炎和声窗不足。临床基线数据、实验室检查和临床风险评分（TRI-SCORE 和 MELD-XI）均包括在内。临床结果是围手术期死亡率，即 30 天内的全因死亡率：最终组群包括 79 名患者。7名患者（9%）在隔离电视手术后30天内死亡，达到了终点。ROC 曲线分析显示，在右心室功能参数中，右心室游离壁纵向应变是预测围手术期死亡率的最佳参数（AUC：0.854，95% CI 0.74-0.96，P = 0.在单变量分析中，左心室射血分数、糖尿病、肌酐、估计肾小球滤过率、血清钠、MELD-XI、TRI-SCORE、右心室面积、右心室整体纵向应变、右心室游离壁纵向应变、分数面积变化和右心室游离壁纵向应变/肺动脉收缩压之比均与终点显著相关。通过斑点追踪超声心动图评估右心室收缩功能的TRI-SCORE和右心室Strain组合在预后预测方面优于经典的TRI-SCORE（AUC为0.874 vs 0,787，P值=0.05）：右心室游离壁纵向应变比传统参数具有更高的预后价值，并能显著提高临床评分预测接受孤立电视手术患者围手术期死亡率的能力。
Short-term outcome after isolated tricuspid valve surgery: prognostic role of right ventricular strain.
Objectives: To assess the incremental prognostic value of right ventricular free wall longitudinal strain over conventional risk scores in predicting the peri-operative mortality in patients with severe tricuspid regurgitation (TR) undergoing isolated tricuspid valve (TV) surgery.
Methods: We retrospectively enrolled 110 consecutive patients with severe TR who underwent isolated TV surgery between November 2016 and July 2022 at San Raffaele Hospital, Milan, Italy. Exclusion criteria were previous TV surgery, urgent surgery, complex congenital heart disease, active endocarditis and inadequate acoustic window. Baseline clinical data were included, as well as laboratory tests and clinical risk score, as TRI-SCORE and MELD-XI. The clinical outcome was peri-operative mortality, defined as all-cause mortality within 30 days.
Results: The final cohort included 79 patients. The end-point occurred in 7 patients (9%), who died within 30 days after isolated TV surgery. Receiver operator characteristic curves analysis showed that, among parameters of right ventricular function, right ventricular free wall longitudinal strain was the best parameter to predict peri-operative mortality (AUC: 0.854, 95% CI 0.74-0.96, P = 0.005, sensitivity 68%, specificity 100%). At univariable analysis, left ventricular ejection fraction, diabetes mellitus, creatinine, estimated glomerular filtration rate, serum sodium, MELD-XI, TRI-SCORE, right ventricular areas, right ventricular global longitudinal strain, right ventricular free wall longitudinal strain, fractional area change and the ratio between right ventricular free wall longitudinal strain/pulmonary arterial systolic pressure were significantly associated with the end-point. The combination of TRI-SCORE and right ventricular Strain, evaluating right ventricular systolic function with speckle-tracking echocardiography, outperformed classic TRI-SCORE in outcome prediction (AUC 0.874 vs 0.787, P = 0.05).
Conclusions: Right ventricular free wall longitudinal strain has an incremental prognostic value over conventional parameters and significantly improves the ability of clinical scores to predict peri-operative mortality in patients undergoing isolated TV surgery.
期刊介绍：
The primary aim of the European Journal of Cardio-Thoracic Surgery is to provide a medium for the publication of high-quality original scientific reports documenting progress in cardiac and thoracic surgery. The journal publishes reports of significant clinical and experimental advances related to surgery of the heart, the great vessels and the chest. The European Journal of Cardio-Thoracic Surgery is an international journal and accepts submissions from all regions. The journal is supported by a number of leading European societies.
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