A multicenter study published in the Journal of the American Society of Echocardiography has found that three-dimensional (3D) right ventricular ejection fraction (RVEF) is a powerful predictor of adverse outcomes following cardiac surgery compared to traditional measures of right heart function. It also refined the risk prediction when combined with existing scoring tools.

In a prospective analysis involving 248 adult patients undergoing cardiac surgery, researchers evaluated the right ventricular (RV) function using transesophageal echocardiography before surgery. The primary goal was to determine whether 3D RVEF could predict a composite outcome of in-hospital mortality or the need for temporary ventricular assist device support, independent of the EuroSCORE II risk stratification system.

Patients had a median age of 69 years, and 43% were female. While 69% of patients exhibited normal RVEF (≥45%), the remaining had impaired RV function. Those with reduced RVEF demonstrated significantly worse readings in other RV function parameters, such as RV free-wall longitudinal strain and tricuspid annular plane systolic excursion.

The study found that 11% of patients met the primary adverse outcome. Notably, after adjusting for EuroSCORE II, decreased RVEF remained independently associated with this outcome (hazard ratio: 2.46; 95% CI: 1.10–5.50; P = .028). Furthermore, 3D RVEF was superior to other RV parameters in predicting poor outcomes (P = .006).

At 30 days, survival free of the primary outcome was 93% in patients with normal RVEF compared to just 72% in those with reduced RVEF (P < .001). Lower RVEF also correlated with longer durations on mechanical ventilation and inotropic support.