Preoperative Right Ventricular Echocardiographic Parameters Predict Perioperative Cardiovascular Complications in Patients Undergoing Non-Cardiac Surgery

Background Transthoracic echocardiography is frequently ordered before non-cardiac surgery (NCS), but the impact of preoperative echocardiography on perioperative outcomes in patients undergoing NCS is unknown. The present study aimed to evaluate the predictive value of preoperative right ventricular echocardiograhic parameters for the occurrence of perioperative cardiovascular complications (PCC) in patients undergoing NCS. Method We reviewed the data of 660 patients aged >= 18 years and over (mean age 66.3 +/- 15 yr) who underwent preoperative comprehensive echocardiography before elective NCS between January 2015 and February 2019. Only patients who had undergone echocardiography before NCS were included. Echocardiographic measurements of right ventricular function, including tricuspid annular plane systolic excursion (TAPSE), Tei index, right ventricular fractional area change, and pulmonary artery systolic pressure, were retrospectively evaluated. The primary outcome of the study was major PCC defined as cardiac death, non-fatal cardiac arrest, severe arrhythmias requiring treatment, acute heart failure, acute coronary syndrome, pulmonary thrombo-embolism, and cardio-embolic stroke. Results Eighty (80) patients (12.1%) experienced PCC. Patients with PCC were older, and had a higher prevalence of coronary artery disease, heart failure, and diabetes mellitus. Patients with PCC had lower TAPSE (16.9 +/- 4.4 vs 20.8 +/- 4.2 mm; p<0.001) than patients without PCC. Multivariate logistic regression analysis showed that older age (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.25-4.65; p<0.01), presence of diabetes (OR, 1.78; 95% CI, 0.95-3.46; p=0.03), and TAPSE <17.6mm (OR, 3.12; 95% CI, 1.12-5.46; p=0.03) were significant variables associated with PCC. Conclusions This is the first study to demonstrate that preoperative reduced right ventricular systolic function, as measured by TAPSE, is associated with increased rates of perioperative adverse cardiac events in patients undergoing NCS.