Why the study?
Perioperative RV dysfunction increases morbidity and mortality in cardiac surgery, prompting evaluation of intraoperative RV PV loop and ESPVR generation using routinely available intraoperative monitoring data.
Can intraoperative right ventricular pressure-volume loops be feasibly generated using routine hemodynamic and echocardiographic data in patients undergoing cardiac surgery?
Can intraoperative right ventricular pressure-volume loops be feasibly generated using routine hemodynamic and echocardiographic data in patients undergoing cardiac surgery?
It is clinically feasible to derive right ventricular pressure-volume loops from routine intraoperative hemodynamic and echocardiographic data, offering a potential real-time monitoring tool for RV function during cardiac surgery.
RV PV loop analysis is feasible with routine monitors; hypothesis-generating for perioperative RV assessment in cardiac surgery.
Background Perioperative right ventricular (RV) dysfunction is associated with increased morbidity and mortality in cardiac surgery patients. This study aimed to demonstrate proof of concept in generating intraoperative RV pressure–volume (PV) loops and conducting an end-systolic PV relationship (ESPVR) analysis using data obtained from routinely used intraoperative monitors. Methods Adult patients undergoing cardiac surgery with the placement of a pulmonary artery catheter (PAC) between May 2023 and March 2024 were included prospectively. The PV loops were generated using 3-dimensional echocardiographic RV volume data and continuous RV pressure data obtained from a PAC. The volume–time and pressure–time curves were digitized using the semiautomatic WebPlotDigitizer program and synchronized to reconstruct an RV PV loop and analyze ESPVR using the previously validated single-beat method. Results Intraoperative RV PV loops were generated for 25 patients, including 17 patients with preserved RV systolic function (group 1) and 8 patients with reduced systolic function (group 2). Mean E es , E a , and E es /E a ratio were 0.63 ± 0.25 mm Hg/mL, 0.60 ± 0.23 mm Hg/mL, and 1.0 8 ± 0.31 mm Hg/mL, respectively, by the P max method and 0.56 ± 0.32 mm Hg/mL, 0.60 ± 0.23 mm Hg/mL, and 0.91 ± 0.21 mm Hg/mL, respectively, by the V 0 method. Group 1 had a significantly higher E es compared to group 2 regardless of the calculation method and a larger E es /E a ratio calculated by the V 0 method. Conclusions It is clinically feasible to derive RV PV loops from routine hemodynamic and echocardiographic data. With further validation and technological support, this can be a potential real-time intraoperative RV function monitoring tool.
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Kiarad et al. (2024) studied this question.
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