Edith L. Posada-Martinez MD , Juan B. Ivey-Miranda MD, PHD , Xochitl A. Ortiz-Leon MD , Jose A. Arias-Godinez MD , Juan F. Fritche-Salazar MD , Hugo G. Rodriguez-Zanella MD , Maria E. Ruiz Esparza-Dueñas MD , Diana Romero-Zertuche MD , Ivan I. Silvestre-Flores MD , Julieta Morales-Portano MD , Arturo Orea-Tejeda MD, PHD , Jorge Rojas-Serrano MD, PHD , Robert L. McNamara MD, MHS , Pedro A. Reyes Lopez MD, PHD , Lissa Sugeng MD, MPH
{"title":"心脏手术患者三维右心室射血分数与住院预后的关系多中心研究。","authors":"Edith L. Posada-Martinez MD , Juan B. Ivey-Miranda MD, PHD , Xochitl A. Ortiz-Leon MD , Jose A. Arias-Godinez MD , Juan F. Fritche-Salazar MD , Hugo G. Rodriguez-Zanella MD , Maria E. Ruiz Esparza-Dueñas MD , Diana Romero-Zertuche MD , Ivan I. Silvestre-Flores MD , Julieta Morales-Portano MD , Arturo Orea-Tejeda MD, PHD , Jorge Rojas-Serrano MD, PHD , Robert L. McNamara MD, MHS , Pedro A. Reyes Lopez MD, PHD , Lissa Sugeng MD, MPH","doi":"10.1016/j.echo.2025.02.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Aims</h3><div>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.</div></div><div><h3>Methods and results</h3><div>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 (<em>P</em> < .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; <em>P</em> = .028). Importantly, 3D RVEF was superior to all other parameters of RV systolic function to predict the primary outcome (<em>P</em> = .006). At 30 days, survival free of the primary end point was 72% ± 8% versus 93% ± 3% (<em>P</em> < .001) in decreased versus normal RVEF, respectively. Right ventricular ejection fraction was associated with shorter time on mechanical ventilation (<em>r</em> = −0.27, <em>P</em> < .001) and shorter time on inotropes (<em>r</em> = −0.20, <em>P</em> = .01).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 8","pages":"Pages 685-693"},"PeriodicalIF":6.0000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association Between Three-Dimensional Right Ventricular Ejection Fraction and In-Hospital Outcomes in Patients Undergoing Cardiac Surgery: A Multicenter Study\",\"authors\":\"Edith L. Posada-Martinez MD , Juan B. Ivey-Miranda MD, PHD , Xochitl A. Ortiz-Leon MD , Jose A. Arias-Godinez MD , Juan F. Fritche-Salazar MD , Hugo G. Rodriguez-Zanella MD , Maria E. Ruiz Esparza-Dueñas MD , Diana Romero-Zertuche MD , Ivan I. Silvestre-Flores MD , Julieta Morales-Portano MD , Arturo Orea-Tejeda MD, PHD , Jorge Rojas-Serrano MD, PHD , Robert L. McNamara MD, MHS , Pedro A. Reyes Lopez MD, PHD , Lissa Sugeng MD, MPH\",\"doi\":\"10.1016/j.echo.2025.02.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Aims</h3><div>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.</div></div><div><h3>Methods and results</h3><div>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 (<em>P</em> < .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; <em>P</em> = .028). Importantly, 3D RVEF was superior to all other parameters of RV systolic function to predict the primary outcome (<em>P</em> = .006). At 30 days, survival free of the primary end point was 72% ± 8% versus 93% ± 3% (<em>P</em> < .001) in decreased versus normal RVEF, respectively. Right ventricular ejection fraction was associated with shorter time on mechanical ventilation (<em>r</em> = −0.27, <em>P</em> < .001) and shorter time on inotropes (<em>r</em> = −0.20, <em>P</em> = .01).</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":50011,\"journal\":{\"name\":\"Journal of the American Society of Echocardiography\",\"volume\":\"38 8\",\"pages\":\"Pages 685-693\"},\"PeriodicalIF\":6.0000,\"publicationDate\":\"2025-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Society of Echocardiography\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0894731725001026\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Society of Echocardiography","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0894731725001026","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Association Between Three-Dimensional Right Ventricular Ejection Fraction and In-Hospital Outcomes in Patients Undergoing Cardiac Surgery: A Multicenter Study
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.
期刊介绍:
The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.