Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction?
Abstract Aims The PREPARE‐MVR study (PRediction of Early PostoperAtive Right vEntricular failure in Mitral Valve Replacement/Repair patients) sought to investigate the alterations of right ventricular (RV) contraction pattern in patients undergoing mitral valve replacement/repair (MVR) and to explor...
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Wiley
2020-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.12682 |
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| author | Márton Tokodi Endre Németh Bálint K. Lakatos Erika Kispál Zoltán Tősér Levente Staub Kristóf Rácz Ádám Soltész Szabolcs Szigeti Tamás Varga János Gál Béla Merkely Attila Kovács |
| author_facet | Márton Tokodi Endre Németh Bálint K. Lakatos Erika Kispál Zoltán Tősér Levente Staub Kristóf Rácz Ádám Soltész Szabolcs Szigeti Tamás Varga János Gál Béla Merkely Attila Kovács |
| author_sort | Márton Tokodi |
| collection | DOAJ |
| description | Abstract Aims The PREPARE‐MVR study (PRediction of Early PostoperAtive Right vEntricular failure in Mitral Valve Replacement/Repair patients) sought to investigate the alterations of right ventricular (RV) contraction pattern in patients undergoing mitral valve replacement/repair (MVR) and to explore the associations between pre‐operative RV mechanics and early post‐operative RV dysfunction (RVD). Methods and results We prospectively enrolled 42 patients (63 ± 11 years, 69% men) undergoing open‐heart MVR. Transthoracic three‐dimensional (3D) echocardiography was performed pre‐operatively, at intensive care unit discharge, and 6 months after surgery. The 3D model of the RV was reconstructed, and RV ejection fraction (RVEF) was calculated. We decomposed the motion of the ventricle to compute longitudinal ejection fraction (LEF) and radial ejection fraction (REF). Pulmonary artery catheterization was performed to monitor RV stroke work index (RVSWi). RVEF was slightly decreased after MVR [52 (50–55) vs. 51 (46–54)%; P = 0.001], whereas RV contraction pattern changed notably. Before MVR, the longitudinal shortening was the main contributor to global systolic RV function [LEF/RVEF vs. REF/RVEF; 0.53 (0.47–0.58) vs. 0.33 (0.22–0.42); P < 0.001]. Post‐operatively, the radial motion became dominant [0.33 (0.28–0.43) vs. 0.46 (0.37–0.51); P = 0.004]. However, this shift was temporary as 6 months later the two components contributed equally to global RV function [0.44 (0.38–0.50) vs. 0.41 (0.36–0.49); P = 0.775]. Pre‐operative LEF was an independent predictor of post‐operative RVD defined as RVSWi < 300 mmHg⋅mL/m2 [OR = 1.33 (95% CI: 1.08–1.77), P < 0.05]. Conclusions MVR induces a significant shift in the RV mechanical pattern. Advanced indices of RV mechanics are associated with invasively measured parameters of RV contractility and may predict post‐operative RVD. |
| format | Article |
| id | doaj-art-a5ee824e7c344484b7d17173342244d4 |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2020-06-01 |
| publisher | Wiley |
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| series | ESC Heart Failure |
| spelling | doaj-art-a5ee824e7c344484b7d17173342244d42025-02-03T10:25:46ZengWileyESC Heart Failure2055-58222020-06-01731246125610.1002/ehf2.12682Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction?Márton Tokodi0Endre Németh1Bálint K. Lakatos2Erika Kispál3Zoltán Tősér4Levente Staub5Kristóf Rácz6Ádám Soltész7Szabolcs Szigeti8Tamás Varga9János Gál10Béla Merkely11Attila Kovács12Heart and Vascular Center Semmelweis University Budapest HungaryDepartment of Anesthesiology and Intensive Therapy Semmelweis University Budapest HungaryHeart and Vascular Center Semmelweis University Budapest HungaryHeart and Vascular Center Semmelweis University Budapest HungaryArgus Cognitive, Inc. Lebanon NH USAArgus Cognitive, Inc. Lebanon NH USADepartment of Anesthesiology and Intensive Therapy Semmelweis University Budapest HungaryDepartment of Anesthesiology and Intensive Therapy Semmelweis University Budapest HungaryDepartment of Anesthesiology and Intensive Therapy Semmelweis University Budapest HungaryDepartment of Anesthesiology and Intensive Therapy Semmelweis University Budapest HungaryDepartment of Anesthesiology and Intensive Therapy Semmelweis University Budapest HungaryHeart and Vascular Center Semmelweis University Budapest HungaryHeart and Vascular Center Semmelweis University Budapest HungaryAbstract Aims The PREPARE‐MVR study (PRediction of Early PostoperAtive Right vEntricular failure in Mitral Valve Replacement/Repair patients) sought to investigate the alterations of right ventricular (RV) contraction pattern in patients undergoing mitral valve replacement/repair (MVR) and to explore the associations between pre‐operative RV mechanics and early post‐operative RV dysfunction (RVD). Methods and results We prospectively enrolled 42 patients (63 ± 11 years, 69% men) undergoing open‐heart MVR. Transthoracic three‐dimensional (3D) echocardiography was performed pre‐operatively, at intensive care unit discharge, and 6 months after surgery. The 3D model of the RV was reconstructed, and RV ejection fraction (RVEF) was calculated. We decomposed the motion of the ventricle to compute longitudinal ejection fraction (LEF) and radial ejection fraction (REF). Pulmonary artery catheterization was performed to monitor RV stroke work index (RVSWi). RVEF was slightly decreased after MVR [52 (50–55) vs. 51 (46–54)%; P = 0.001], whereas RV contraction pattern changed notably. Before MVR, the longitudinal shortening was the main contributor to global systolic RV function [LEF/RVEF vs. REF/RVEF; 0.53 (0.47–0.58) vs. 0.33 (0.22–0.42); P < 0.001]. Post‐operatively, the radial motion became dominant [0.33 (0.28–0.43) vs. 0.46 (0.37–0.51); P = 0.004]. However, this shift was temporary as 6 months later the two components contributed equally to global RV function [0.44 (0.38–0.50) vs. 0.41 (0.36–0.49); P = 0.775]. Pre‐operative LEF was an independent predictor of post‐operative RVD defined as RVSWi < 300 mmHg⋅mL/m2 [OR = 1.33 (95% CI: 1.08–1.77), P < 0.05]. Conclusions MVR induces a significant shift in the RV mechanical pattern. Advanced indices of RV mechanics are associated with invasively measured parameters of RV contractility and may predict post‐operative RVD.https://doi.org/10.1002/ehf2.12682Mitral valve regurgitationMitral valve surgeryRight ventricleRight ventricular dysfunction3D echocardiography |
| spellingShingle | Márton Tokodi Endre Németh Bálint K. Lakatos Erika Kispál Zoltán Tősér Levente Staub Kristóf Rácz Ádám Soltész Szabolcs Szigeti Tamás Varga János Gál Béla Merkely Attila Kovács Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction? ESC Heart Failure Mitral valve regurgitation Mitral valve surgery Right ventricle Right ventricular dysfunction 3D echocardiography |
| title | Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction? |
| title_full | Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction? |
| title_fullStr | Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction? |
| title_full_unstemmed | Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction? |
| title_short | Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction? |
| title_sort | right ventricular mechanical pattern in patients undergoing mitral valve surgery a predictor of post operative dysfunction |
| topic | Mitral valve regurgitation Mitral valve surgery Right ventricle Right ventricular dysfunction 3D echocardiography |
| url | https://doi.org/10.1002/ehf2.12682 |
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