Keast, T. et al. (2023) Study protocol for IMPRoVE: a multicentre prospective observational cohort study of the incidence, impact and mechanisms of perioperative right ventricular dysfunction in non-cardiac surgery. BMJ Open, 13(9), e074687. (doi: 10.1136/bmjopen-2023-074687) (PMID:37673452) (PMCID:PMC10496661)
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Abstract
Introduction: Perioperative myocardial injury evidenced by elevated cardiac biomarkers (both natriuretic peptides and troponin) is common after major non-cardiac surgery. However, it is unclear if the rise in cardiac biomarkers represents global or more localised cardiac injury. We have previously shown isolated right ventricular (RV) dysfunction in patients following lung resection surgery, with no change in left ventricular (LV) function. Given that perioperative RV dysfunction (RVD) can manifest insidiously, we hypothesise there may be a substantial burden of covert yet clinically important perioperative RVD in other major non-cardiac surgical groups. The Incidence, impact and Mechanisms of Perioperative Right VEntricular dysfunction (IMPRoVE) study has been designed to address this knowledge gap. Methods and analysis: A multicentre prospective observational cohort study across four centres in the West of Scotland and London. One hundred and seventy-five patients will be recruited from five surgical specialties: thoracic, upper gastrointestinal, vascular, colorectal and orthopaedic surgery (35 patients from each group). All patients will undergo preoperative and postoperative (day 2–4) echocardiography, with contemporaneous cardiac biomarker testing. Ten patients from each surgical specialty (50 patients in total) will undergo T1-cardiovascular magnetic resonance (CMR) imaging preoperatively and postoperatively. The coprimary outcomes are the incidence of perioperative RVD (diagnosed by RV speckle tracking echocardiography) and the effect that RVD has on days alive and at home at 30 days postoperatively. Secondary outcomes include LV dysfunction and clinical outcomes informed by Standardised Endpoints in Perioperative Medicine consensus definitions. T1 CMR will be used to investigate for imaging correlates of myocardial inflammation as a possible mechanism driving perioperative RVD. Ethics and dissemination: Approval was gained from Oxford C Research Ethics Committee (REC reference 22/SC/0442). Findings will be disseminated by various methods including social media, international presentations and publication in peer-reviewed journals. Trial registration number: NCT05827315.
| Item Type: | Articles |
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| Additional Information: | This study is supported by the National Institute of Academic Anaesthesia/ Royal College of Anaesthetists British Oxygen Company Chair of Anaesthesia Research Grant. CB is supported by the BHF Centre of Research Excellence grant (reference number RE/18/6/34217). GA is supported by the NIHR Advanced Fellowship (NIHR300097). |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Berry, Professor Colin and Watson, Dr Malcolm and Robertson, Dr Keith and Shelley, Dr Benjamin and Keast, Dr Tom and Kearns, Dr Rachel and McCall, Dr Philip and Greenlaw, Miss Nicola and McKinlay, Dr Sonya and McErlane, Dr James |
| Authors: | Keast, T., McErlane, J., Kearns, R., McKinlay, S., Raju, I., Watson, M., Robertson, K. E., Berry, C., Greenlaw, N., Ackland, G., McCall, P., and Shelley, B. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
| Journal Name: | BMJ Open |
| Publisher: | BMJ Publishing Group |
| ISSN: | 2044-6055 |
| ISSN (Online): | 2044-6055 |
| Published Online: | 06 September 2023 |
| Copyright Holders: | Copyright © 2023 The Authors |
| First Published: | First published in BMJ Open 13(9): e074687 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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