Background

Three-dimensional (3D) right ventricular (RV) strain analysis is not routinely performed perioperatively. Although 3D RV strain adds incrementally to outcome prediction in various cardiac diseases, its role in the perioperative setting is not sufficiently understood. The aim of this study was to investigate the association between 3D RV strain measured on RV meshes created from 3D transesophageal echocardiographic data and short-term outcomes among patients undergoing cardiac surgery.

Methods

A total of 496 patients undergoing cardiac surgery who underwent intraoperative 3D transesophageal echocardiography (under general anesthesia, before sternotomy) were retrospectively selected, and RV meshes were generated using commercially available speckle-tracking software. Custom-made software automatically quantified longitudinal and circumferential RV strains on the mesh surfaces. Echocardiographic and clinical parameters were entered into logistic regression models to determine their associations with the primary (in-hospital death or need for extracorporeal life support) and secondary (postoperative ventilation > 48 hours) end points.

Results

Mesh-derived RV strain analysis was feasible in 94% of patients and revealed distinct regional patterns with basal-apical gradients for both longitudinal and circumferential strain. Thirty-seven patients (7.6%) reached the primary end point, and 118 patients (23.8%) reached the secondary end point. In a multivariable logistic regression model, serum lactate (P < .01), an emergency indication for surgery (P < .01), tricuspid regurgitation (P < .001), and mesh-derived RV global longitudinal strain (RV-GLS; P < .01) were independently associated with the primary end point, while established measures of RV function (3D RV ejection fraction, fractional area change, tricuspid annular plane systolic excursion) and left ventricular (LV) function (3D-derived LV ejection fraction and LV-GLS) were not independently associated. Hematocrit (P < .01), serum lactate (P < .001), pulmonary hypertension (P = .04), tricuspid regurgitation (P < .01), emergency procedures (P = .02), LV-GLS (P = .02), and RV-GLS (P < .001) were associated with the secondary end point.

Conclusions

RV-GLS measured on RV meshes derived from 3D transesophageal echocardiography was independently associated with short-term outcomes in patients undergoing cardiac surgery and might be helpful for identifying patients at risk for adverse postoperative events.

中文翻译：

---

三维网格衍生的右心室应变与接受心脏手术的患者的短期结果的关联

背景

围手术期不常规进行三维 (3D) 右心室 (RV) 应变分析。尽管 3D RV 应变逐渐增加了各种心脏病的结果预测，但其在围手术期中的作用尚未得到充分了解。本研究的目的是调查根据 3D 经食道超声心动图数据创建的 RV 网格上测量的 3D RV 应变与接受心脏手术的患者的短期结果之间的关联。

方法

回顾性选择了 496 名接受心脏手术的患者，他们接受了术中 3D 经食道超声心动图（在全身麻醉下，胸骨切开术前），并使用市售的散斑跟踪软件生成了 RV 网格。定制软件自动量化网格表面上的纵向和周向 RV 应变。将超声心动图和临床参数输入逻辑回归模型以确定它们与主要（院内死亡或需要体外生命支持）和次要（术后通气 > 48 小时）终点的关联。

结果

网格衍生的 RV 应变分析在 94% 的患者中是可行的，并揭示了纵向和周向应变的具有基底-顶端梯度的不同区域模式。37 名患者（7.6%）达到主要终点，118 名患者（23.8%）达到次要终点。在多变量逻辑回归模型中，血清乳酸 ( P  < .01)、紧急手术指征 ( P  < .01)、三尖瓣关闭不全 ( P  < .001) 和网片衍生的 RV 整体纵向应变 (RV-GLS;磷 < .01) 与主要终点独立相关，而建立的 RV 功能（3D RV 射血分数、面积变化分数、三尖瓣环平面收缩偏移）和左心室 (LV) 功能（3D 衍生的 LV 射血分数和LV-GLS）没有独立关联。红细胞比容 ( P  < .01)、血清乳酸 ( P  < .001)、肺动脉高压 ( P  = .04)、三尖瓣关闭不全 ( P  < .01)、紧急手术 ( P  = .02)、LV-GLS ( P  = .02) 和 RV-GLS ( P  < .001) 与次要终点相关。

结论

在源自 3D 经食道超声心动图的 RV 网格上测量的 RV-GLS 与接受心脏手术的患者的短期结果独立相关，并且可能有助于识别有术后不良事件风险的患者。