title: Prognostic value of right ventricular two-dimensional global strain in patients referred for cardiac surgery.
abstract: BACKGROUND
  Right ventricular (RV) function is a strong predictor of patient outcome after cardiac surgery. Limited studies have compared the predictive value of RV global longitudinal strain (RV-GLS) with tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RVFAC) in this setting.
  
  
  METHODS
  The study included 250 patients (66 ± 13 years old, LVEF = 52% ± 12%) referred for cardiac surgery (EuroSCORE-II = 4.8% ± 8.0%). RV function before surgery was assessed by RV-GLS by using speckle-tracking analysis (3-segment from the RV free wall), RVFAC and TAPSE was compared with postoperative outcome defined by 1-month mortality.
  
  
  RESULTS
  Overall, 19 patients (7.6%) had RVFAC < 35%, 34 (13.6%) had TAPSE < 16 mm, and 99 (39.6%) had impaired RV-GLS > -21% (35% with normal RVFAC ≥ 35%). Postoperative death (n = 25) was higher in patients with abnormal RV-GLS > -21% (22% vs 3%; P < .0001), TAPSE < 16 mm (24% vs 8%; P = .007), and RVFAC < 35% (32% vs 9%; P = .001). Mortality was 3% in patients with preserved RV-GLS. In patients with preserved RVFAC ≥ 35% but abnormal RV-GLS, mortality was similar to that of those with RVFAC < 35% (20% vs 32%; P = .12). Among RV systolic indexes, only RV-GLS was associated with patient outcome by multivariate analysis adjusted to EuroSCORE-II and cardiopulmonary bypass duration.
  
  
  CONCLUSIONS
  RV-GLS is a sensitive marker of RV dysfunction and correlates with postoperative mortality.
authors.affiliation: AP-HP for Assistance-Publique Hôpitaux de Paris, Henri Mondor University Hospital, Cardiovascular Department and INSERM U955, Team #3, Creteil, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Ternacle
authors.forename: Matthieu
authors.initials: M
authors.lastname: Berry
authors.forename: Thomas
authors.initials: T
authors.lastname: Cognet
authors.forename: Martin
authors.initials: M
authors.lastname: Kloeckner
authors.forename: Thibaud
authors.initials: T
authors.lastname: Damy
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Monin
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Couetil
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Dubois-Rande
authors.forename: Pascal
authors.initials: P
authors.lastname: Gueret
authors.forename: Pascal
authors.initials: P
authors.lastname: Lim
mesh_terms: D000368:Aged; D019540:Area Under Curve; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D016009:Chi-Square Distribution; D015897:Comorbidity; D015150:Echocardiography, Doppler; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008297:Male; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology*