The right ventricular response to lung resection

McCall, P. J. , Arthur, A., Glass, A., Corcoran, D. S., Kirk, A., Macfie, A., Payne, J., Johnson, M., Kinsella, J. and Shelley, B. G. (2019) The right ventricular response to lung resection. Journal of Thoracic and Cardiovascular Surgery, 158(2), 556-565.e5. (doi:10.1016/j.jtcvs.2019.01.067) (PMID:30826095)

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Abstract

Objectives: Lung cancer is a leading cause of cancer death and in suitable cases the best chance of cure is offered by surgery. Lung resection is associated with significant postoperative cardiorespiratory morbidity, with dyspnea and reduced functional capacity as dominant features. These changes are poorly associated with deterioration in pulmonary function and a potential role of right ventricular (RV) dysfunction has been hypothesized. Cardiovascular magnetic resonance imaging is a reference method for noninvasive assessment of RV function and has not previously been applied to this population. Methods: We used cardiovascular magnetic resonance imaging to assess the RV response to lung resection. Cardiovascular magnetic resonance imaging with volume and flow analysis was performed on 27 patients preoperatively, on postoperative day 2 and at 2 months. Left ventricular ejection fraction and RV ejection fraction, the ratio of stroke volume to end systolic volume, pulmonary artery acceleration time, and distensibility of main and branch pulmonary arteries were studied. Results: Mean ± standard deviation RV ejection fraction deteriorated from 50.5% ± 6.9% preoperatively to 45.6% ± 4.5% on postoperative day 2 and remained depressed at 44.9% ± 7.7% by 2 months (P = .003). The ratio of stroke volume to end systolic volume deteriorated from median 1.0 (quartile 1, quartile 3, 0.9, 1.2) preoperatively to median 0.8 (quartile 1, quartile 3, 0.7, 1.0) on postoperative day 2 (P = .011). On postoperative day 2 there was a decrease in pulmonary artery acceleration time and operative pulmonary artery distensibility (P < .030 for both). There were no changes in left ventricular ejection fraction during the study period (P = .621). Conclusions: These findings suggest RV dysfunction occurs following lung resection and persists 2 months after surgery. The deterioration in the ratio of stroke volume to end systolic volume suggests a mismatch between afterload and contractility. There is an increase in indices of pulsatile afterload resulting from the operative pulmonary artery.

Item Type:Articles
Additional Information:Funding for this project was provided by the Association for Cardiothoracic Anaesthesia and Critical Care Project Grant 2012; £26,932. DC is supported by a British Heart Foundation (BHF) Clinical Research Training Fellowship [FS/14/15/30661]. BS is supported by a NHS Research Scotland / Chief Scientists Office, Career Research Fellowship.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Kirk, Mr Alan and Glass, Dr Adam and Shelley, Dr Ben and Johnson, Dr Martin and Arthur, Dr Alexander and McCall, Dr Philip and Corcoran, Dr David and MacFie, Dr Alistair and Kinsella, Professor John
Authors: McCall, P. J., Arthur, A., Glass, A., Corcoran, D. S., Kirk, A., Macfie, A., Payne, J., Johnson, M., Kinsella, J., and Shelley, B. G.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of Thoracic and Cardiovascular Surgery
Publisher:Elsevier
ISSN:0022-5223
ISSN (Online):1097-685X
Published Online:26 January 2019
Copyright Holders:Copyright © 2019 The American Association for Thoracic Surgery
First Published:First published in Journal of Thoracic and Cardiovascular Surgery 158(2):556-565.e5
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
628691Microvascular Dysfunction in Patients with Angina: The CE-MARC2 Microvascular SubstudyColin BerryBritish Heart Foundation (BHF)FS/14/15/30661RI CARDIOVASCULAR & MEDICAL SCIENCES