Recent research has shed light on the predictive capabilities of three-dimensional (3D) echocardiography concerning adverse outcomes following cardiac surgery, particularly focusing on right ventricular (RV) mechanics. A study from Eberhard Karls University Tuebingen, Germany, revealed significant associations between 3D RV global longitudinal strain (GLS) and postoperative complications, enhancing the role of echocardiographic assessments in patient risk stratification.
Granular preoperative risk assessment is imperative for improving cardiac surgery outcomes. Traditionally, echocardiography has been instrumental for diagnosing heart conditions and assessing perioperative risk. Yet, many conventional measures fall short when it involves complex geometric and contraction patterns of the RV. This is where 3D echo technology steps in, promising more accurate results.
The study was anchored on two cohorts—retrospective and prospective—evaluated using intraoperative 3D transesophageal echocardiography. The researchers analyzed clinical and echocardiographic data from 439 patients treated from June 2015 to October 2018, as well as from 128 patients evaluated between June 2020 and July 2021. "RV longitudinal deformation derived from 3D echocardiography is predictive of adverse outcomes and should be incorporated in perioperative risk stratification," the authors of the article stated.
Results indicated associations between various echocardiographic parameters, such as the degree of tricuspid regurgitation, left ventricular (LV) ejection fraction, and RV GLS, with the risk of adverse postoperative outcomes—defined as mortality, prolonged mechanical ventilation, or acute kidney injury. Notably, the study identified a cutoff point for RV GLS at -17.4%, where values worse than this threshold correlated with nearly threefold increased risk for complications.
The prospective data confirmed the findings, demonstrating comparable predictive value and reinforcing the necessity for integrating comprehensive RV assessments during preoperative evaluations. The use of 3D echocardiography could address existing gaps in risk assessment protocols used today, which focus predominantly on left ventricular function without direct consideration of RV performance.
By applying sophisticated echocardiographic techniques, healthcare professionals can improve the identification of patients at high risk for unfavorable outcomes during cardiac surgery, allowing for enhanced management strategies. This includes both potential alterations to surgical approaches (such as selecting off-pump techniques) and more rigorous preoperative preparation involving hemodynamic management.
The findings present not just statistical correlations but actionable insights, which could shape clinical decision-making based on individual patient risk profiles. The authors suggest, "an RV GLS worse than -17.4% was associated with approximately threefold increase in the risk for adverse outcomes," emphasising these 3D metrics' clinical relevance.
With the efficiency of 3D echo becoming more established, the medical community stands to benefit from lower complication rates through informed risk stratification. Overall, the study advocates for the routine application of 3D echocardiographic measures to enrich surgical risk assessments and optimize patient outcomes.
Future research aims to validate these findings across varied patient populations to solidify the generalizability of 3D echocardiography-derived RV function metrics as reliable predictors of postoperative risk.