Right Ventricular Assessment by 2D Speckle-Tracking Echocardiography Before CABG in Patients With Preserved or Mild Left Ventricular Systolic Function

Document Type : Original Article


1 Heart Center, Department of Medical Sciences, Tehran University of Medical Sciences, Tehran, IR Iran.

2 Department of Internal Medical Sciences, Qom University of Medical Sciences, Qom, IR Iran.

3 Student Research Committee, School of Medicine, Qom University of Medical Sciences, Qom, IR Iran.

4 Open Heart Intensive Care Unit, Cardiology Department, Tehran University of Medical Sciences, Tehran, IR Iran.

5 Heart Research Center, Tehran University of Medical Sciences, Tehran, IR Iran.

6 Department of Family and Community Medicine, School of Medicine, Qom University of Medical Sciences, Qom, IR Iran.


Background: Data indicate the predictive role of abnormal right ventricular (RV) strain values in postoperative outcomes after coronary artery bypass grafting (CABG). Hence, we aimed to investigate the impact of RV strain assessment by 2D speckle-tracking echocardiography in predicting post-CABG complications.
Methods: This study analyzed 149 consecutive low-risk patients with preserved left ventricular (LV) and normal RV function concerning echo parameters, including LV ejection fraction and right ventricular free wall longitudinal strain (RVFWLS), undergoing isolated CABG. RVFWLS was assessed with 2D speckle-tracking echocardiography before surgery. Abnormal RVFWLS was defined as absolute RVFWLS < 19%. The adjusted effects of absolute RVFWLS strain and abnormal RVFWLS on the risk of ICU complications were assessed.
Results: Of 149 patients, 90 (60.4%) had abnormal preoperative RVFWLS (−16.5 ± 1.98). There were no significant associations between abnormal RVFWLS and postoperative serum creatinine rise, atrial fibrillation, ventilation time, inotrope use, cumulative dose, on-pump CABG, cardiopulmonary bypass duration, and length of ICU stay (all Ps > 0.05). Postoperative ICU complications were not correlated with absolute RV strain values, except for ventilation time, which had a statistically significant but clinically negligible association with absolute RV strain values (regression coefficient = 1.035; P = 0.016). Since ventilation time is short (< 2 min), despite the positive statistical correlation, it had no clinical value.
Conclusions: RV strain measurements by 2D speckle-tracking echocardiography added no benefits to the prediction of ICU complications in low-risk patients undergoing CABG who had preserved or mildly impaired systolic LV function. (Iranian Heart Journal 2024; 25(1): 82-92)


  1. Haddad F, Doyle R, Murphy DJ, Hunt SA. Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation. 2008; 117(13):1717-31.
  2. Haddad F, Denault AY, Couture P, Cartier R, Pellerin M, Levesque S, et al. Right ventricular myocardial performance index predicts perioperative mortality or circulatory failure in high-risk valvular surgery. Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography. 2007; 20(9):1065-72.
  3. Stämpfli SF, Donati TG, Hellermann J, Anwer S, Erhart L, Gruner C, et al. Right ventricle and outcome in left ventricular non-compaction cardiomyopathy. J Cardiol. 2020; 75(1):20-6.
  4. Bening C, Sales VL, Alhussini K, Radakovic D, Benitez RC, Madrahimov N, et al. Clinically inapparent right heart dysfunction is associated with reduced myofilament force development in coronary artery disease. BMC Cardiovasc Disord. 2021; 21(1):125.
  5. Chinikar M, Rafiee M, Aghajankhah M, Gholipour M, Hasandokht T, Imantalab V, et al. Right ventricular dysfunction and associated factors in patients after coronary artery bypass grafting. ARYA atherosclerosis. 2019; 15(3):99-105.
  6. Guinot PG, Abou-Arab O, Longrois D, Dupont H. Right ventricular systolic dysfunction and vena cava dilatation precede alteration of renal function in adult patients undergoing cardiac surgery: An observational study. European journal of anaesthesiology. 2015; 32(8):535-42.
  7. Maslow AD, Regan MM, Panzica P, Heindel S, Mashikian J, Comunale ME. Precardiopulmonary bypass right ventricular function is associated with poor outcome after coronary artery bypass grafting in patients with severe left ventricular systolic dysfunction. Anesthesia and analgesia. 2002; 95(6):1507-18, table of contents.
  8. Lella LK, Sales VL, Goldsmith Y, Chan J, Iskandir M, Gulkarov I, et al. Reduced Right Ventricular Function Predicts Long-Term Cardiac Re-Hospitalization after Cardiac Surgery. PloS one. 2015; 10(7):e0132808.
  9. Alam M, Hedman A, Nordlander R, Samad B. Right ventricular function before and after an uncomplicated coronary artery bypass graft as assessed by pulsed-wave Doppler tissue imaging of the tricuspid annulus. Am Heart J. 2003; 146(3):520-6.
  10. Haddad F, Hunt SA, Rosenthal DN, Murphy DJ. Right ventricular function in cardiovascular disease, part I: Anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation. 2008; 117(11):1436-48.
  11. Kang DK, Lim SH, Park JS, Sun JS, Ha T, Kim TH. Clinical utility of early postoperative cardiac multidetector computed tomography after coronary artery bypass grafting. Scientific reports. 2020; 10(1):9186.
  12. Pouleur AC, Rousseau MF, Ahn SA, Amzulescu M, Demeure F, de Meester C, et al. Right Ventricular Systolic Dysfunction Assessed by Cardiac Magnetic Resonance Is a Strong Predictor of Cardiovascular Death After Coronary Bypass Grafting. The Annals of thoracic surgery. 2016; 101(6):2176-84.
  13. Poorhosseini H, Abbasi SH. The Tehran Heart Center. Eur Heart J. 2018 Aug 1; 39(29):2695-2696. doi:10.1093/eurheartj/ehy369.
  14. Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 1999; 16(1):9-13.
  15. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama. 2013; 310(20):2191-4.
  16. Badano LP, Kolias TJ, Muraru D, Abraham TP, Aurigemma G, Edvardsen T, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. European heart journal cardiovascular Imaging. 2018; 19(6):591-600.
  17. Morris DA, Krisper M, Nakatani S, Köhncke C, Otsuji Y, Belyavskiy E, et al. Normal range and usefulness of right ventricular systolic strain to detect subtle right ventricular systolic abnormalities in patients with heart failure: a multicentre study. European heart journal cardiovascular Imaging. 2017; 18(2):212-23.
  18. Saxena A, Paramanathan A, Shi WY, Dinh DT, Reid CM, Smith JA, et al. impact of left ventricular dysfunction on early and late outcomes in patients undergoing concomitant aortic valve replacement and coronary artery bypass graft surgery. Cardiology journal. 2013;20(4):423-30.
  19. Ji Q, Xia LM, Shi YQ, Ma RH, Shen JQ, Ding WJ, et al. impact of severe left ventricular dysfunction on in-hospital and mid-term outcomes of Chinese patients undergoing first isolated off-pump coronary artery bypass grafting. Journal of cardiothoracic surgery. 2017; 12(1):87.
  20. Mandoli GE, Cameli M, Novo G, Agricola E, Righini FM, Santoro C, et al. Right ventricular function after cardiac surgery: the diagnostic and prognostic role of echocardiography. Heart failure reviews. 2019; 24(5):625-35.
  21. Kukulski T, She L, Racine N, Gradinac S, Panza JA, Velazquez EJ, et al. Implication of right ventricular dysfunction on long-term outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. The Journal of thoracic and cardiovascular surgery. 2015; 149(5):1312-21.
  22. Tabernacle J, Berry M, Cognet T, Kloeckner M, Damy T, Monin JL, et al. Prognostic value of right ventricular two-dimensional global strain in patients referred for cardiac surgery. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 2013; 26(7):721-6.
  23. Yockelson SR, Heitner SB, Click S, Geleto G, Treggiari MM, Hutchens MP. Right Ventricular Systolic Performance Determined by 2D Speckle-Tracking Echocardiography and Acute Kidney Injury After Cardiac Surgery. Journal of cardiothoracic and vascular anesthesia. 2019; 33(3):725-31.
  24. Lanspa MJ, Cirulis MM, Wiley BM, Olsen TD, Wilson EL, Beesley SJ, et al. Right Ventricular Dysfunction in Early Sepsis and Septic Shock. Chest. 2021; 159(3):1055-63.