Right Ventricular Systolic Performance Determined by 2D Speckle-Tracking Echocardiography and Acute Kidney Injury After Cardiac Surgery

Shaun R. Yockelson, Stephen Heitner, Sarah Click, Gemechu Geleto, Miriam Treggiari, Michael Hutchens

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Abstract

Objective: An association between central venous pressure and acute kidney injury (AKI) has been observed following cardiac surgery, but it is unknown whether this reflects intravascular volume status or impaired right ventricular (RV) myocardial performance. This study was performed to test the hypothesis that decreased RV peak longitudinal strain (PLSS), as measured by 2-dimensional speckle-tracking echocardiography, is associated with AKI following cardiac surgery. Design: Retrospective observational cohort study. Setting: Cardiovascular intensive care unit in a 576-bed referral hospital. Participants: Adult patients having undergone cardiac surgery in whom a transthoracic echocardiogram (TTE) was performed within 48 hours after chest closure. Interventions: This was a retrospective study. Urine output and serum creatinine values were recorded at baseline and for 48 hours after surgery. Statistical analysis was performed to identify differences in baseline demographic and echo-derived values between patients with and without postoperative AKI criteria. Measurements and Main Results: One hundred ninety-nine subjects had postprocessing of TTE performed. AKI was observed in 87% of patients (173 of 199). Age, body mass index, and preoperative serum creatinine were higher in the AKI group. The mean PLSS was -17.2% ± 4.3% versus -17.1% ± 3.7% in patients with AKI versus those without (p = 0.95). The calculated RV systolic pressure was elevated in the AKI group compared to the non-AKI group (38.9 ± 9.9 v 34.6 ± 7.9 mmHg, p = 0.02). Conclusion: In this cohort of cardiac surgery patients, speckle-tracking analysis of RV myocardial performance was feasible. Elevated RV systolic pressure associated with AKI, while speckle tracking-derived echocardiography measurements did not.

Original languageEnglish (US)
JournalJournal of Cardiothoracic and Vascular Anesthesia
DOIs
StateAccepted/In press - Jan 1 2018

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Acute Kidney Injury
Thoracic Surgery
Echocardiography
Ventricular Pressure
Creatinine
Patient Identification Systems
Blood Pressure
Central Venous Pressure
Serum
Observational Studies
Intensive Care Units
Body Mass Index
Cohort Studies
Thorax
Referral and Consultation
Retrospective Studies
Demography
Urine
Kidney
Wounds and Injuries

Keywords

  • acute kidney injury
  • cardiac surgical procedures
  • cardiorenal syndrome
  • echocardiography
  • postoperative care
  • ventricular function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

@article{c35a7310d24f4114978aacb1f1a52770,
title = "Right Ventricular Systolic Performance Determined by 2D Speckle-Tracking Echocardiography and Acute Kidney Injury After Cardiac Surgery",
abstract = "Objective: An association between central venous pressure and acute kidney injury (AKI) has been observed following cardiac surgery, but it is unknown whether this reflects intravascular volume status or impaired right ventricular (RV) myocardial performance. This study was performed to test the hypothesis that decreased RV peak longitudinal strain (PLSS), as measured by 2-dimensional speckle-tracking echocardiography, is associated with AKI following cardiac surgery. Design: Retrospective observational cohort study. Setting: Cardiovascular intensive care unit in a 576-bed referral hospital. Participants: Adult patients having undergone cardiac surgery in whom a transthoracic echocardiogram (TTE) was performed within 48 hours after chest closure. Interventions: This was a retrospective study. Urine output and serum creatinine values were recorded at baseline and for 48 hours after surgery. Statistical analysis was performed to identify differences in baseline demographic and echo-derived values between patients with and without postoperative AKI criteria. Measurements and Main Results: One hundred ninety-nine subjects had postprocessing of TTE performed. AKI was observed in 87{\%} of patients (173 of 199). Age, body mass index, and preoperative serum creatinine were higher in the AKI group. The mean PLSS was -17.2{\%} ± 4.3{\%} versus -17.1{\%} ± 3.7{\%} in patients with AKI versus those without (p = 0.95). The calculated RV systolic pressure was elevated in the AKI group compared to the non-AKI group (38.9 ± 9.9 v 34.6 ± 7.9 mmHg, p = 0.02). Conclusion: In this cohort of cardiac surgery patients, speckle-tracking analysis of RV myocardial performance was feasible. Elevated RV systolic pressure associated with AKI, while speckle tracking-derived echocardiography measurements did not.",
keywords = "acute kidney injury, cardiac surgical procedures, cardiorenal syndrome, echocardiography, postoperative care, ventricular function",
author = "Yockelson, {Shaun R.} and Stephen Heitner and Sarah Click and Gemechu Geleto and Miriam Treggiari and Michael Hutchens",
year = "2018",
month = "1",
day = "1",
doi = "10.1053/j.jvca.2018.09.012",
language = "English (US)",
journal = "Journal of Cardiothoracic and Vascular Anesthesia",
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TY - JOUR

T1 - Right Ventricular Systolic Performance Determined by 2D Speckle-Tracking Echocardiography and Acute Kidney Injury After Cardiac Surgery

AU - Yockelson, Shaun R.

AU - Heitner, Stephen

AU - Click, Sarah

AU - Geleto, Gemechu

AU - Treggiari, Miriam

AU - Hutchens, Michael

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: An association between central venous pressure and acute kidney injury (AKI) has been observed following cardiac surgery, but it is unknown whether this reflects intravascular volume status or impaired right ventricular (RV) myocardial performance. This study was performed to test the hypothesis that decreased RV peak longitudinal strain (PLSS), as measured by 2-dimensional speckle-tracking echocardiography, is associated with AKI following cardiac surgery. Design: Retrospective observational cohort study. Setting: Cardiovascular intensive care unit in a 576-bed referral hospital. Participants: Adult patients having undergone cardiac surgery in whom a transthoracic echocardiogram (TTE) was performed within 48 hours after chest closure. Interventions: This was a retrospective study. Urine output and serum creatinine values were recorded at baseline and for 48 hours after surgery. Statistical analysis was performed to identify differences in baseline demographic and echo-derived values between patients with and without postoperative AKI criteria. Measurements and Main Results: One hundred ninety-nine subjects had postprocessing of TTE performed. AKI was observed in 87% of patients (173 of 199). Age, body mass index, and preoperative serum creatinine were higher in the AKI group. The mean PLSS was -17.2% ± 4.3% versus -17.1% ± 3.7% in patients with AKI versus those without (p = 0.95). The calculated RV systolic pressure was elevated in the AKI group compared to the non-AKI group (38.9 ± 9.9 v 34.6 ± 7.9 mmHg, p = 0.02). Conclusion: In this cohort of cardiac surgery patients, speckle-tracking analysis of RV myocardial performance was feasible. Elevated RV systolic pressure associated with AKI, while speckle tracking-derived echocardiography measurements did not.

AB - Objective: An association between central venous pressure and acute kidney injury (AKI) has been observed following cardiac surgery, but it is unknown whether this reflects intravascular volume status or impaired right ventricular (RV) myocardial performance. This study was performed to test the hypothesis that decreased RV peak longitudinal strain (PLSS), as measured by 2-dimensional speckle-tracking echocardiography, is associated with AKI following cardiac surgery. Design: Retrospective observational cohort study. Setting: Cardiovascular intensive care unit in a 576-bed referral hospital. Participants: Adult patients having undergone cardiac surgery in whom a transthoracic echocardiogram (TTE) was performed within 48 hours after chest closure. Interventions: This was a retrospective study. Urine output and serum creatinine values were recorded at baseline and for 48 hours after surgery. Statistical analysis was performed to identify differences in baseline demographic and echo-derived values between patients with and without postoperative AKI criteria. Measurements and Main Results: One hundred ninety-nine subjects had postprocessing of TTE performed. AKI was observed in 87% of patients (173 of 199). Age, body mass index, and preoperative serum creatinine were higher in the AKI group. The mean PLSS was -17.2% ± 4.3% versus -17.1% ± 3.7% in patients with AKI versus those without (p = 0.95). The calculated RV systolic pressure was elevated in the AKI group compared to the non-AKI group (38.9 ± 9.9 v 34.6 ± 7.9 mmHg, p = 0.02). Conclusion: In this cohort of cardiac surgery patients, speckle-tracking analysis of RV myocardial performance was feasible. Elevated RV systolic pressure associated with AKI, while speckle tracking-derived echocardiography measurements did not.

KW - acute kidney injury

KW - cardiac surgical procedures

KW - cardiorenal syndrome

KW - echocardiography

KW - postoperative care

KW - ventricular function

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U2 - 10.1053/j.jvca.2018.09.012

DO - 10.1053/j.jvca.2018.09.012

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JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

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