Association of 3D Mesh-Derived Right Ventricular Strain with Short-Term Outcome in Patients Undergoing Cardiac Surgery.

Abstract: Background 3D right ventricular (RV) strain analysis is not routinely performed perioperatively. While 3D RV strain adds incrementally to outcome prediction in various cardiac diseases, its role in the perioperative setting is not sufficiently understood. This study investigated the association between 3D RV strain measured on RV meshes created from 3D transesophageal echocardiography (TEE) data and short-term outcomes of patients undergoing cardiac surgery. Methods A total of 496 patients undergoing cardiac surgery who underwent intraoperative 3D TEE (under general anesthesia, before sternotomy) were retrospectively selected and RV meshes were generated using commercially available speckle-tracking software. Custom-made software automatically quantified longitudinal and circumferential RV strains on the mesh surfaces. Echocardiographic and clinical parameters were entered into logistic regression models to determine their association with the primary (in-hospital death or need for extracorporeal life support) and secondary endpoints (postoperative ventilation >48 hours). Results Mesh-derived RV strain analysis was feasible in 94% of patients and revealed distinct regional patterns with basal-apical gradients for both longitudinal and circumferential strain. Thirty-seven patients (7.6%) reached the primary endpoint, and 118 patients (23.8%) reached the secondary endpoint. In a multivariable logistic regression model, serum lactate (p Conclusions RV-GLS measured on RV meshes derived from 3D TEE was independently associated with short-term outcomes in patients undergoing cardiac surgery and might be helpful for identifying patients at risk for adverse postoperative events.