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Association Between Three-Dimensional Right Ventricular Ejection Fraction and In-Hospital Outcomes in Patients

Edith L Posada-Martinez1, Juan B Ivey-Miranda2, Xochitl A Ortiz-Leon1

  • 1Echocardiography Department, Instituto Nacional de Cardiología "Ignacio Chavez", Mexico City, Mexico.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|February 21, 2025
PubMed
Summary

Three-dimensional right ventricular ejection fraction (3D RVEF) is a strong predictor of outcomes in cardiac surgery patients. Incorporating 3D RVEF may improve risk stratification and patient outcomes after surgery.

Keywords:
Cardiac surgeryEchocardiographyRight ventricular ejection fractionRight ventricular functionThree-dimensional echocardiography

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Echocardiography

Background:

  • Accurate risk stratification is crucial for cardiac surgery.
  • Current risk scores often lack assessment of right ventricular (RV) function.
  • RV dysfunction can significantly impact surgical outcomes.

Purpose of the Study:

  • To evaluate if three-dimensional RV ejection fraction (3D RVEF) predicts outcomes in cardiac surgery patients.
  • To compare the predictive value of 3D RVEF against other RV function parameters.
  • To determine if 3D RVEF improves risk stratification beyond existing scores like EuroSCORE II.

Main Methods:

  • Prospective multicenter study involving 248 adult patients undergoing cardiac surgery.
  • Transesophageal echocardiography was used to analyze RV function parameters preoperatively.
  • Association of 3D RVEF with a composite primary outcome (in-hospital mortality or need for ventricular assist device) was assessed, adjusting for EuroSCORE II.

Main Results:

  • Decreased 3D RVEF was independently associated with adverse outcomes after adjusting for EuroSCORE II (HR=2.46, P=0.028).
  • 3D RVEF demonstrated superior predictive ability for the primary outcome compared to other RV function parameters (P=0.006).
  • Patients with decreased RVEF had significantly lower survival free of the primary endpoint at 30 days (72% vs 93%, P<0.001) and longer durations on mechanical ventilation and inotropes.

Conclusions:

  • Three-dimensional RV ejection fraction is the strongest predictor of in-hospital mortality or need for temporary ventricular assist device in cardiac surgery patients.
  • The study suggests that 3D RVEF should be incorporated into the preoperative evaluation for cardiac surgery.
  • Including 3D RVEF may enhance the accuracy of risk stratification for patients undergoing cardiac surgery.