Use of intraoperative right ventricular strain as a predictor of outcomes in adult heart transplant patients.
6 affiliations
- 1Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States.
- 2Echocardiography Laboratory, Vanderbilt University Medical Center, Nashville, TN, United States.
- 3Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, United States.
- 4Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
- 5Vanderbilt University School of Medicine, Nashville, TN, United States.
- 6Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States.
Abstract
Background
Right ventricle (RV) evaluation in the perioperative period is challenging for anesthesiologists, given the limited objective assessment methods available for transesophageal echocardiography (TEE). Speckle-tracking strain imaging may offer a more objective evaluation of RV function. This study evaluated the predictive value of intraoperative RV free wall strain (RVFWS) for early outcomes following orthotopic heart transplantation (OHT).Methods
This was a single-center retrospective cohort study of 147 adults who underwent isolated OHT between January 2025 and December 2025. Patients with multiorgan transplant, congenital cases, and those without measurable intraoperative RVFWS were excluded. Post-bypass RVFWS was measured using TEE at a single time point with speckle-tracking analysis. The primary outcome was 90-day mortality. Secondary outcomes included severe primary graft dysfunction, 30-day mortality, need for postoperative venoarterial extracorporeal membrane oxygenation and continuous renal replacement therapy (CRRT), vasoactive-inotropic score, and cardiac index at 24 and 72 h, and intensive care unit length of stay. Multivariable Firth-penalized logistic and median quantile regressions were used, adjusted for a priori pre-transplant weighted risk score.Results
The median post-bypass RVFWS was -13.9% IQR (interquartile range) -19.3 to -9.6. Fourteen recipients (9.5%) died within 90 days of transplantation. After adjusting for the pre-transplant risk score, RVFWS was independently associated with higher 90-day mortality [odds ratio (OR) 2.84 per 5% decrease in magnitude, 95% confidence interval 1.65-5.58; p < 0.001]. Among the secondary outcomes, the associations with severe primary graft dysfunction (OR 2.70; raw p = 0.001), CRRT (OR 1.58; raw p = 0.001), and 30-day mortality (OR 2.94; raw p = 0.002) remained statistically significant after Bonferroni adjustment for eleven secondary comparisons (adjusted p = 0.011, 0.011, and 0.022, respectively). RVFWS demonstrated higher discrimination for 90-day mortality [area under the curve (AUC) 0.83] than qualitative intraoperative RV grading (AUC 0.68), although this difference in AUC did not reach statistical significance. RVFWS retained independent prognostic value in a combined model.Conclusions
Intraoperative post-bypass RVFWS is a feasible and objective intraoperative measure that is independently associated with early adverse outcomes after adult OHT. RVFWS shows promise as a signal of early allograft dysfunction that is not fully explained by pre-transplant risk factors.
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BibTeX
@article{bryant2026intraoperative,
title = {{Use of intraoperative right ventricular strain as a predictor of outcomes in adult heart transplant patients.}},
author = {John Bryant and Becky Settlemire and Awab Ahmad and Robert Deegan and Drexel A Neumann and Bantayehu Sileshi and Aaron Williams and Swaroop Bommareddi and John Trahanas and Kelly Schlendorf and Mark Petrovic and Chen Chia Wang and Afif Kraitem and Neal Duggal and Taylor Ziegler and Amit Jhaveri and Michael Baker and Mias Pretorius and Ashish Shah and Christina Anne Jelly and Brian Lima},
journal = {Frontiers in cardiovascular medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1890033},
url = {https://europepmc.org/article/MED/42909099},
note = {CC BY},
}
RIS
TY - JOUR
TI - Use of intraoperative right ventricular strain as a predictor of outcomes in adult heart transplant patients.
AU - John Bryant
AU - Becky Settlemire
AU - Awab Ahmad
AU - Robert Deegan
AU - Drexel A Neumann
AU - Bantayehu Sileshi
AU - Aaron Williams
AU - Swaroop Bommareddi
AU - John Trahanas
AU - Kelly Schlendorf
AU - Mark Petrovic
AU - Chen Chia Wang
AU - Afif Kraitem
AU - Neal Duggal
AU - Taylor Ziegler
AU - Amit Jhaveri
AU - Michael Baker
AU - Mias Pretorius
AU - Ashish Shah
AU - Christina Anne Jelly
AU - Brian Lima
PY - 2026
DA - 2026/10/07
JO - Frontiers in cardiovascular medicine
DO - 10.3389/fcvm.2026.1890033
UR - https://europepmc.org/article/MED/42909099
AB - Background Right ventricle (RV) evaluation in the perioperative period is challenging for anesthesiologists, given the limited objective assessment methods available for transesophageal echocardiography (TEE). Speckle-tracking strain imaging may offer a more objective evaluation of RV function. This study evaluated the predictive value of intraoperative RV free wall strain (RVFWS) for early outcomes following orthotopic heart transplantation (OHT).Methods This was a single-center retrospective cohort study of 147 adults who underwent isolated OHT between January 2025 and December 2025. Patients with multiorgan transplant, congenital cases, and those without measurable intraoperative RVFWS were excluded. Post-bypass RVFWS was measured using TEE at a single time point with speckle-tracking analysis. The primary outcome was 90-day mortality. Secondary outcomes included severe primary graft dysfunction, 30-day mortality, need for postoperative venoarterial extracorporeal membrane oxygenation and continuous renal replacement therapy (CRRT), vasoactive-inotropic score, and cardiac index at 24 and 72 h, and intensive care unit length of stay. Multivariable Firth-penalized logistic and median quantile regressions were used, adjusted for a priori pre-transplant weighted risk score.Results The median post-bypass RVFWS was -13.9% IQR (interquartile range) -19.3 to -9.6. Fourteen recipients (9.5%) died within 90 days of transplantation. After adjusting for the pre-transplant risk score, RVFWS was independently associated with higher 90-day mortality [odds ratio (OR) 2.84 per 5% decrease in magnitude, 95% confidence interval 1.65-5.58; p < 0.001]. Among the secondary outcomes, the associations with severe primary graft dysfunction (OR 2.70; raw p = 0.001), CRRT (OR 1.58; raw p = 0.001), and 30-day mortality (OR 2.94; raw p = 0.002) remained statistically significant after Bonferroni adjustment for eleven secondary comparisons (adjusted p = 0.011, 0.011, and 0.022, respectively). RVFWS demonstrated higher discrimination for 90-day mortality [area under the curve (AUC) 0.83] than qualitative intraoperative RV grading (AUC 0.68), although this difference in AUC did not reach statistical significance. RVFWS retained independent prognostic value in a combined model.Conclusions Intraoperative post-bypass RVFWS is a feasible and objective intraoperative measure that is independently associated with early adverse outcomes after adult OHT. RVFWS shows promise as a signal of early allograft dysfunction that is not fully explained by pre-transplant risk factors.
SN - 2297-055X
ER -