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Gitundu S, Gonzalez-Ciccarelli LF, Gebhardt BR, Cobey FC. Evaluating the Role of Right Ventricular Free Wall Longitudinal Strain as a Noninvasive Metric for Stroke Volume, Stroke Volume Index, and Right Ventricular Function. J Cardiothorac Vasc Anesth 2025:S1053-0770(25)00216-2. [PMID: 40158928 DOI: 10.1053/j.jvca.2025.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 03/05/2025] [Accepted: 03/10/2025] [Indexed: 04/02/2025]
Affiliation(s)
- Samwel Gitundu
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | | | - Brian R Gebhardt
- Department of Anesthesiology and Perioperative Medicine, UMass Memorial Medical Center, Worcester, MA
| | - Frederick C Cobey
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA.
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Alavi N, Van Klei W, Agyei K, Zabida A, Abraha M, Salvatori M, Mashari A, Bartoszko J. The association of right ventricular function with outcomes after cardiac surgery: a systematic review. Can J Anaesth 2025; 72:285-318. [PMID: 39939498 DOI: 10.1007/s12630-024-02898-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 02/14/2025] Open
Abstract
PURPOSE Assessment of right ventricular (RV) function is recommended as part of a comprehensive echocardiography exam, including before and after cardiac surgery. Nevertheless, the prognostic implications of various measures of RV function in patients undergoing cardiac surgery are not well characterized. Our goal was to conduct a focused systematic review to assess the association of quantitative parameters of RV function with postoperative outcomes in patients undergoing cardiac surgery. METHODS We conducted a systematic review of randomized controlled trials or observational studies in adult (≥ 18 yr) patients undergoing cardiac surgery with a reported echocardiogram within six months of surgery, intraoperatively, or shortly after surgery. We excluded case reports and case series. Databases included PubMed® and MEDLINE, and papers published from 1 January 1990 to 22 April 2024 were searched for. The primary predictors of interest were quantitative RV function parameters. The primary outcome of interest was postoperative mortality up to five years. The secondary outcome was all major adverse cardiac events (MACE). RESULTS We identified 7,187 potentially relevant studies, 27 of which were included; all of these were observational studies. Right ventricular fractional area change (RVFAC) was the most commonly reported parameter, but was inconsistently associated with mortality and MACE. Tricuspid annular plane systolic excursion (TAPSE) and strain were consistently associated with mortality. The most consistent predictor of MACE was RV myocardial performance index (MPI) across studies. CONCLUSION Pre- and perioperative assessment of RV function using at least two quantitative echocardiographic parameters may offer prognostic information in patients undergoing cardiac surgery. Right ventricular FAC, TAPSE, strain, and RV MPI have been frequently studied; however, further research is needed to delineate the role of echocardiographic RV quantification for perioperative prognostication. STUDY REGISTRATION PROSPERO ( CRD42023387383 ); first submitted 23 December 2022.
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Affiliation(s)
- Neeki Alavi
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Wilton Van Klei
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kwame Agyei
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Amir Zabida
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Mosana Abraha
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marcus Salvatori
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Azad Mashari
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Justyna Bartoszko
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada.
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Anaesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, 3EN-464, Toronto, ON, M5G 2C4, Canada.
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