Alavi Neeki, Van Klei Wilton, Agyei Kwame, Zabida Amir, Abraha Mosana, Salvatori Marcus, Mashari Azad, Bartoszko Justyna
Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada.
Institute of Medical Science, University of Toronto, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2025 Feb;72(2):285-318. doi: 10.1007/s12630-024-02898-9. Epub 2025 Feb 12.
Assessment of right ventricular (RV) function is recommended as part of a comprehensive echocardiography exam, including before and after cardiac surgery. Nevertheless, the prognostic implications of various measures of RV function in patients undergoing cardiac surgery are not well characterized. Our goal was to conduct a focused systematic review to assess the association of quantitative parameters of RV function with postoperative outcomes in patients undergoing cardiac surgery.
We conducted a systematic review of randomized controlled trials or observational studies in adult (≥ 18 yr) patients undergoing cardiac surgery with a reported echocardiogram within six months of surgery, intraoperatively, or shortly after surgery. We excluded case reports and case series. Databases included PubMed® and MEDLINE, and papers published from 1 January 1990 to 22 April 2024 were searched for. The primary predictors of interest were quantitative RV function parameters. The primary outcome of interest was postoperative mortality up to five years. The secondary outcome was all major adverse cardiac events (MACE).
We identified 7,187 potentially relevant studies, 27 of which were included; all of these were observational studies. Right ventricular fractional area change (RVFAC) was the most commonly reported parameter, but was inconsistently associated with mortality and MACE. Tricuspid annular plane systolic excursion (TAPSE) and strain were consistently associated with mortality. The most consistent predictor of MACE was RV myocardial performance index (MPI) across studies.
Pre- and perioperative assessment of RV function using at least two quantitative echocardiographic parameters may offer prognostic information in patients undergoing cardiac surgery. Right ventricular FAC, TAPSE, strain, and RV MPI have been frequently studied; however, further research is needed to delineate the role of echocardiographic RV quantification for perioperative prognostication.
PROSPERO ( CRD42023387383 ); first submitted 23 December 2022.
右心室（RV）功能评估被推荐作为全面超声心动图检查的一部分，包括心脏手术前后。然而，心脏手术患者中各种右心室功能测量指标的预后意义尚未得到充分阐明。我们的目标是进行一项重点系统评价，以评估右心室功能定量参数与心脏手术患者术后结局之间的关联。
我们对成人（≥18岁）心脏手术患者进行了系统评价，这些患者在术后6个月内、术中或术后不久有超声心动图报告。我们排除了病例报告和病例系列。数据库包括PubMed®和MEDLINE，并检索了1990年1月1日至2024年4月22日发表的论文。感兴趣的主要预测因素是右心室功能定量参数。感兴趣的主要结局是长达五年的术后死亡率。次要结局是所有主要不良心脏事件（MACE）。
我们识别出7187项潜在相关研究，其中27项被纳入；所有这些都是观察性研究。右心室面积变化分数（RVFAC）是最常报告的参数，但与死亡率和MACE的关联不一致。三尖瓣环平面收缩期位移（TAPSE）和应变与死亡率始终相关。在各项研究中，MACE最一致的预测因素是右心室心肌性能指数（MPI）。
使用至少两个定量超声心动图参数对右心室功能进行术前和围手术期评估，可能为心脏手术患者提供预后信息。右心室FAC、TAPSE、应变和右心室MPI已被频繁研究；然而，需要进一步研究来阐明超声心动图右心室定量在围手术期预后评估中的作用。
PROSPERO（CRD42023387383）；于2022年12月23日首次提交。
