title: Influence of right ventricular function on the development of primary graft dysfunction after lung transplantation.
abstract: BACKGROUND
  Primary graft dysfunction (PGD) remains a significant cause of lung transplant postoperative morbidity and mortality. The underlying mechanisms of PGD development are not completely understood. This study analyzed the effect of right ventricular function (RVF) on PGD development.
  
  
  METHODS
  A retrospective analysis of a prospectively assessed cohort was performed at a single institution between July 2010 and June 2013. The primary outcome was development of PGD grade 3 (PGD3). Conventional echocardiographic parameters and speckle-tracking echocardiography, performed during the pre-transplant evaluation phase up to 1 year before surgery, were used to assess preoperative RVF.
  
  
  RESULTS
  Included were 120 lung transplant recipients (LTr). Systolic pulmonary arterial pressure (48 ± 20 vs 41 ± 18 mm Hg; p = 0.048) and ischemia time (349 ± 73 vs 306 ± 92 minutes; p < 0.01) were higher in LTr who developed PGD3. Patients who developed PGD3 had better RVF estimated by basal free wall longitudinal strain (BLS; -24% ± 9% vs -20% ± 6%; p = 0.039) but had a longer intensive care unit length of stay and mechanical ventilation and higher 6-month mortality. BLS ≥ -21.5% was the cutoff that best identified patients developing PGD3 (area under the receiver operating characteristic curve, 0.70; 95% confidence interval, 0.54-0.85; p = 0.020). In the multivariate analysis, a BLS ≥ -21.5% was an independent risk factor for PGD3 development (odds ratio, 4.56; 95% confidence interval, 1.20-17.38; p = 0.026), even after adjusting for potential confounding.
  
  
  CONCLUSIONS
  A better RVF, as measured by BLS, is a risk factor for severe PGD. Careful preoperative RVF assessment using speckle-tracking echocardiography may identify LTrs with the highest risk of developing PGD.
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: puperez@vhebron.net.
authors.forename: Purificación
authors.initials: P
authors.lastname: Pérez-Terán
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain; CibeRes (Ciber de Enfermedades Respiratorias), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: Roca
authors.affiliation: Cardiology.
authors.forename: José
authors.initials: J
authors.lastname: Rodríguez-Palomares
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain.
authors.forename: Judit
authors.initials: J
authors.lastname: Sacanell
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain.
authors.forename: Sandra
authors.initials: S
authors.lastname: Leal
authors.affiliation: Thoracic Surgery.
authors.forename: Joan
authors.initials: J
authors.lastname: Solé
authors.affiliation: Anesthesiology.
authors.forename: María I
authors.initials: MI
authors.lastname: Rochera
authors.affiliation: Respiratory Departments, Vall d'Hebron University Hospital.
authors.forename: Antonio
authors.initials: A
authors.lastname: Román
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Ruiz-Rodríguez
authors.affiliation: CibeRes (Ciber de Enfermedades Respiratorias), Instituto de Salud Carlos III, Madrid, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Respiratory.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gea
authors.affiliation: Cardiology.
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: CibeRes (Ciber de Enfermedades Respiratorias), Instituto de Salud Carlos III, Madrid, Spain; Respiratory; Critical Care Departments, Hospital del Mar - Parc de Salut Mar de Barcelona, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM).
authors.forename: Joan R
authors.initials: JR
authors.lastname: Masclans
mesh_terms: D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011184:Postoperative Period; D057234:Preoperative Period; D055031:Primary Graft Dysfunction / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: lung transplant; primary graft dysfunction; right ventricle; speckle-tracking echocardiography