Association of Preoperative Echocardiographic Right Ventricular Systolic Function With Outcomes After Cardiac Surgery: A Retrospective Cohort Study

BACKGROUND: Quantitative measures of right ventricular (RV) systolic function, such as RV fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE), are recommended before cardiac surgery. There is little data examining the prognostic significance of quantitative measures on outcomes. METHODS: This single-center, retrospective cohort study investigated the association between quantitative RV systolic function and outcomes in adult patients undergoing coronary artery bypass grafting and/or valve surgery with cardiopulmonary bypass. Logistic and negative binomial regression models were used to determine the association between (1) preoperative TAPSE and (2) RVFAC with in-hospital mortality, hospital length of stay (LOS), and acute kidney injury (AKI). RESULTS: Of 5537 eligible patients, TAPSE and RVFAC were reported within 1 year of surgery in 1913 (35%) and 979 (18%) patients, respectively. TAPSE was associated with mortality (odds ratio [OR] per mm increase, 0.92 and 95% confidence interval [CI], 0.87–0.98; OR for TAPSE <17 mm, 2.15 and 95% CI, 1.16–4.00) and LOS (OR for TAPSE <17 mm, 1.15 and 95% CI, 1.14–1.18), but not AKI. RVFAC was associated with mortality (OR per 1% decrease, 0.92 and 95% CI, 0.88–0.96; OR for RVFAC <35%, 3.66 and 95% CI, 1.58–8.47) and LOS (OR for RVFAC <35%, 1.18 and 95% CI, 1.17–1.21), but not AKI. CONCLUSIONS: In separate analyses, preoperative TAPSE and RVFAC were associated with mortality and LOS, but not AKI. This study highlights the importance of quantitative assessment of the right heart. Future studies must focus on improving echo reporting to facilitate examining the prognostic significance of quantitative RV measures.