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Can Echocardiographic Right Ventricular Function Parameters Predict Vasoactive Support Requirement After Tetralogy of
Siva N Krishna1, Suruchi Hasija1, Sandeep Chauhan1
1Department of Cardiac Anaesthesiology, Cardiothoracic Centre, AIIMS, New Delhi, India.
Insights
Echocardiographic parameters like tricuspid annular plane systolic excursion (TAPSE), right ventricular global longitudinal strain (RV Gls), and RV Gls strain rate (RV Glsr) can predict the need for vasoactive inotropes after tetralogy of Fallot repair. These measurements offer valuable insights into postoperative recovery and management strategies.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Tetralogy of Fallot repair requires careful postoperative management, with vasoactive inotrope requirement being a key indicator of clinical status.
- Assessing right ventricular function is crucial for predicting outcomes after complex congenital heart surgery.
Purpose of the Study:
- To determine if echocardiographic parameters of right ventricular function can predict the need for vasoactive inotropes post-tetralogy of Fallot repair.
- To identify specific echocardiographic measures with predictive value for postoperative vasoactive inotrope requirement.
Main Methods:
- A prospective observational study involving 52 children undergoing tetralogy of Fallot repair at a tertiary care hospital.
- Comprehensive transesophageal echocardiography was performed pre- and post-surgery to assess various right ventricular function parameters.
- Correlation and receiver operating characteristic analyses were used to evaluate the predictive strength of echocardiographic parameters against the Vasoactive-Inotropic Score (VIS).
Main Results:
- Pre- and post-repair tricuspid annular plane systolic excursion (TAPSE) showed a significant negative correlation with mean VIS.
- Right ventricular myocardial performance index, annular velocities (S', E', A'), RV global longitudinal strain (RV Gls), RV Gls strain rate (RV Glsr), and the ratio of right to left ventricular peak systolic pressure (Prv/lv) also correlated significantly with mean VIS.
- TAPSE, RV Gls, RV Glsr, and Prv/lv demonstrated significant predictive strength for high mean VIS (VIS > 20) with reasonable sensitivity and specificity.
Conclusions:
- Tricuspid annular plane systolic excursion (TAPSE), RV global longitudinal strain (RV Gls), RV Gls strain rate (RV Glsr), and the ratio of right to left ventricular peak systolic pressure (Prv/lv) are valuable echocardiographic predictors.
- These parameters can effectively predict a high postoperative vasoactive inotrope requirement after tetralogy of Fallot repair, aiding in clinical decision-making.
Objective:
To evaluate the role of echocardiographic right ventricular function parameters in predicting postoperative vasoactive inotrope requirement after tetralogy of Fallot repair.
Design:
Prospective observational study.
Setting:
A tertiary care hospital.
Participants:
Fifty-two children undergoing elective intracardiac repair.
Interventions:
Comprehensive transesophageal echocardiography was performed before and after surgery. Fractional shortening, fractional area change, tricuspid annular plane systolic excursion (TAPSE), right ventricular myocardial performance index, tricuspid annular velocities (S', E', A'), and right ventricular global longitudinal strain and strain rate (RV Gls and RV Glsr) were measured. The ratio of peak systolic pressure of the right and left ventricles (Prv/lv) was measured directly from the surgical field pre- and post-repair. The inotrope requirement during first 24 postoperative hours was calculated using the mean Vasoactive-Inotropic Score (VIS). Pearson correlation analysis was used to study the relation between echocardiographic parameters and VIS as well as Prv/lv and VIS. Receiver operating characteristic analysis was used to study the predictive strength of parameters.
Measurements And Main Results:
Among the measured parameters, both pre- and post-repair TAPSE had significant negative correlation with the mean VIS (p < 0.05). Both pre- and post-repair right ventricular myocardial performance index and S', E', A', RV Gls, RV Glsr, Prv/lv also had significant correlation with the mean VIS (p < 0.05). Of these, TAPSE, RV Gls, RV Glsr, and Prv/lv had significant predictive strength (p < 0.05) and reasonable sensitivity and specificity (area under the curve > 0.6) for predicting high mean VIS (VIS > 20).
Conclusion:
Tricuspid annular plane systolic excursion, RV Gls, RV Glsr, and Prv/lv could predict a postoperative high mean VIS with significant strength and reasonable sensitivity and specificity.
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