Reduced Right Ventricular Function Predicts Long-Term Cardiac Re-Hospitalization after Cardiac Surgery.

The significance of right ventricular ejection fraction (RVEF), independent of left ventricular ejection fraction (LVEF), following isolated coronary artery bypass grafting (CABG) and valve procedures remains unknown. The aim of this study is to examine the significance of abnormal RVEF by cardiac magnetic resonance (CMR), independent of LVEF in predicting outcomes of patients undergoing isolated CABG and valve surgery.From 2007 to 2009, 109 consecutive patients (mean age, 66 years; 38% female) were referred for pre-operative CMR. Abnormal RVEF and LVEF were considered 30 days) outcomes included, cardiac re-hospitalization, worsening congestive heart failure and mortality. Mean clinical follow up was 14 months.Forty-eight patients had reduced RVEF (mean 25%) and 61 patients had normal RVEF (mean 50%) (p<0.001). Fifty-four patients had reduced LVEF (mean 30%) and 55 patients had normal LVEF (mean 59%) (p<0.001). Patients with reduced RVEF had a higher incidence of long-term cardiac re-hospitalization vs. patients with normal RVEF (31% vs.13%, p<0.05). Abnormal RVEF was a predictor for long-term cardiac re-hospitalization (HR 3.01 [CI 1.5-7.9], p<0.03). Reduced LVEF did not influence long-term cardiac re-hospitalization.Abnormal RVEF is a stronger predictor for long-term cardiac re-hospitalization than abnormal LVEF in patients undergoing isolated CABG and valve procedures

Kaplan-meier survival curve comparing patients with RVEF < 35% (n = 48) and RVEF≥ 35% (n = 61) undergoing CABG or valve procedures.

<p>The top curve corresponds to patients with RVEF <35% and the bottom curve to patients with RVEF≥ 35%. The number below each year indicates the number of patients at risk.</p

Analysis of early (≤ 30-d) and long-term (> 30-d) outcomes associated with RVEF <35% and RVEF ≥ 35%.

<p>ICU, intensive care unit; IQR, interquartile range; LFT, liver function test; postoperative complications (i.e. reoperations for bleeding, early valve reoperations, deep sternal infection, early stroke, early transient ischemic attack, pacemaker implantation, myocardial infarction, atrial fibrillation and renal insufficiency requiring dialysis).</p><p>Analysis of early (≤ 30-d) and long-term (> 30-d) outcomes associated with RVEF <35% and RVEF ≥ 35%.</p

Patient Characteristics.

<p>Cerebral vascular accident, CVA, Pro-BNP, pro-brain natriuretic peptide; LDL, low-density lipoprotein; HDL, high density lipoprotein; RVEF, right ventricular ejection fraction; RVSP, right ventricular systolic pressure; mPAP, mean pulmonary artery pressure; LVEF, left ventricular ejection fraction. Measurements of RV and LV volumes, mass, regional wall motion abnormalities, and function were obtained by CMR; TR and PAP by echocardiography.</p><p>Patient Characteristics.</p

Analysis of early (≤ 30-d) and long-term (> 30-d) outcomes associated with primary CABG and valve procedures.

<p>Early complications within 30-d include reoperations for bleeding, early valve reoperations, deep sternal infection, early stroke, early transient ischemic attack, pacemaker implantation, myocardial infarction, atrial fibrillation, and renal insufficiency requiring dialysis.</p><p>Analysis of early (≤ 30-d) and long-term (> 30-d) outcomes associated with primary CABG and valve procedures.</p

Preoperative CMR.

<p>Short axis cine views traced right ventricle (A), left ventricle (B) and right ventricle from base to the apex (C) for ejection fraction measurements. Marked region of interest is demonstrated in green.</p