Right Ventricular Subclinical Dysfunction as a Predictor of Postoperative Adverse Clinical Outcomes in Patients with Femoral Fracture
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Clinical Data Collection
2.3. Echocardiographic Parameters and Strain Analysis
2.4. Study Outcomes
2.5. Reproducibility of the Strain Analysis
2.6. Statistical Analyses
3. Results
3.1. Baseline Characteristics and Clinical Measurements
3.2. Right Ventricular Strain Analysis and 3D Measurement
3.3. Development of Adverse Clinical Outcomes
3.4. Predictor of Adverse Clinical Events in Patients with Femoral Fracture
3.5. Reproducibility
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Clinical Variables | All (n = 163) | Adverse Outcome Group (n = 36) | Non-Adverse Outcome Group (n = 127) | p |
---|---|---|---|---|
Age, years | 81.39 ± 7.94 | 81.44 ± 10.62 | 79.86 ± 7.13 | 0.364 |
Men, n (%) | 45 (27.61) | 12 (33.33) | 33 (25.98) | 0.510 |
SBP, mmHg | 129.07 ± 21.63 | 132.39 ± 22.64 | 128.23 ± 19.69 | 0.331 |
DBP, mmHg | 73.39 ± 12.55 | 75.56 ± 17.98 | 73.33 ± 9.7 | 0.408 |
HR, beats/min | 80.24 ± 13.28 | 81.58 ± 15.69 | 79.68 ± 12.38 | 0.497 |
Height, cm | 157.31 ± 8.92 | 158.06 ± 8.61 | 156.7 ± 9.75 | 0.483 |
Weight, kg | 56.14 ± 11.59 | 59.64 ± 12.05 | 56.95 ± 11.95 | 0.277 |
BMI, kg/m2 | 22.58 ± 3.75 | 23.69 ± 3.38 | 23.11 ± 4.07 | 0.467 |
Hypertension, n (%) | 124 (76.07) | 26 (72.22) | 98 (77.17) | 0.695 |
Diabetes, n (%) | 75 (46.01) | 16 (44.44) | 59 (46.46) | 0.981 |
Dyslipidemia, n (%) | 35 (21.47) | 5 (13.89) | 30 (23.62) | 0.305 |
Cerebrovascular disease, n (%) | 35 (21.47) | 6 (16.67) | 29 (22.83) | 0.572 |
Atrial fibrillation, n (%) | 12 (7.36) | 5 (13.89) | 7 (5.51) | 0.181 |
Hospital stay, days | 15.68 ± 6.86 | 18.53 ± 8.29 | 14.16 ± 5.48 | 0.002 |
All (n = 163) | Adverse Outcome Group (n = 36) | Non-Adverse Outcome Group (n = 127) | p | |
---|---|---|---|---|
Laboratory parameters | ||||
Hemoglobin, g/dL | 10.74 ± 1.86 | 10.7 ± 1.69 | 10.96 ± 1.77 | 0.480 |
WBC, /mm3 | 8601.53 ± 3039.74 | 9544.44 ± 3886.76 | 8363.01 ± 2506.35 | 0.061 |
Platelet, 103/μL | 191.82 ± 73.15 | 188.86 ± 81.83 | 183.12 ± 65.72 | 0.697 |
Na, mmol/L | 137.0 ± 4.38 | 134.83 ± 6.17 | 137.77 ± 3.88 | 0.003 |
K, mmol/L | 4.03 ± 0.57 | 3.94 ± 0.6 | 4.08 ± 0.53 | 0.218 |
AST, U/L | 31.63 ± 25.22 | 31.86 ± 14.29 | 33.45 ± 34.65 | 0.794 |
ALT, U/L | 20.21 ± 23.76 | 20.42 ± 26.53 | 22.84 ± 27.99 | 0.670 |
BUN, mg/dL | 24.79 ± 17.2 | 24.74 ± 14.7 | 23.48 ± 17.92 | 0.717 |
Creatinine, mg/dL | 1.43 ± 1.74 | 1.4 ± 1.45 | 1.39 ± 1.85 | 0.972 |
eGFR, mL/min/1.73 m2 | 65.23 ± 29.27 | 62.26 ± 30.66 | 68.79 ± 27.71 | 0.272 |
BNP, pg/mL | 244.43 ± 374.61 | 280.87 ± 281.15 | 202.89 ± 360.24 | 0.262 |
CKMB, ng/mL | 5.2 ± 18.67 | 11.49 ± 37.98 | 3.72 ± 6.05 | 0.094 |
Troponin-I, μg/L | 0.05 ± 0.27 | 0.02 ± 0.05 | 0.02 ± 0.09 | 0.610 |
D-dimer, ng/mL | 7439.51 ± 11,057.0 | 10,120.47 ± 14,258.04 | 8043.18 ± 10,494.52 | 0.396 |
CRP, mg/dL | 3.81 ± 5.76 | 5.74 ± 7.26 | 2.07 ± 2.84 | <0.001 |
Echocardiographic parameters | ||||
LVEF, % | 63.38 ± 10.09 | 62.3 ± 11.15 | 63.47 ± 9.34 | 0.569 |
LV EDD, mm | 49.9 ± 5.2 | 50.2 ± 5.3 | 49.8 ± 5.1 | 0.620 |
E, cm/s | 64.51 ± 22.85 | 71.71 ± 31.62 | 62.6 ± 18.83 | 0.066 |
E/A ratio | 0.75 ± 0.68 | 0.74 ± 0.54 | 0.8 ± 0.9 | 0.686 |
E/e’ | 14.18 ± 5.96 | 14.84 ± 8.56 | 14.25 ± 4.89 | 0.650 |
RV s’, cm/s | 13.32 ± 3.37 | 13.15 ± 2.95 | 13.42 ± 3.74 | 0.703 |
TAPSE, mm | 22.77 ± 4.22 | 22.37 ± 3.31 | 22.7 ± 4.81 | 0.710 |
PASP, mmHg | 30.55 ± 10.8 | 30.36 ± 10.75 | 29.34 ± 9.83 | 0.624 |
Tricuspid insufficiency | 0.985 | |||
Trivial | 67 (41%) | 14 (40%) | 53 (42%) | |
Mild | 55 (34%) | 13 (35%) | 43 (34%) | |
Moderate | 31 (19%) | 7 (20%) | 23 (18%) | |
Severe | 10 (6%) | 2 (5%) | 8 (6%) |
All (n = 163) | Adverse Outcome Group (n = 36) | Non-Adverse Outcome Group (n = 127) | p | |
---|---|---|---|---|
RV GLS (%) | −13.73 ± 5.7 | −11.38 ± 5.43 | −14.2 ± 5.62 | 0.015 |
RV free wall GLS (%) | −16.76 ± 7.18 | −14.47 ± 6.79 | −17.49 ± 7.34 | 0.043 |
Basal lateral | −20.87 ± 8.89 | −18.87 ± 9.22 | −21.53 ± 8.87 | 0.153 |
Mid lateral | −16.23 ± 7.04 | −14.48 ± 7.61 | −16.8 ± 6.92 | 0.118 |
Apicolateral | −13.18 ± 7.57 | −10.75 ± 7.03 | −13.81 ± 7.94 | 0.054 |
RVEDV, mL | 89.49 ± 31.21 | 92.62 ± 32.22 | 86.8 ± 29.91 | 0.358 |
RVEDVi, mL/m2 | 55.77 ± 17.28 | 57.24 ± 17.95 | 54.46 ± 16.23 | 0.423 |
RVESV, mL | 55.26 ± 20.76 | 58.77 ± 22.93 | 51.95 ± 17.28 | 0.089 |
RVESVi, mL/m2 | 34.39 ± 11.53 | 36.28 ± 13.06 | 32.54 ± 9.09 | 0.089 |
RV EF by 3D, % | 38.28 ± 9.33 | 36.65 ± 12.5 | 39.69 ± 6.99 | 0.110 |
RV stroke volume (mL) | 35.59 ± 23.36 | 33.93 ± 16.45 | 37.89 ± 30.54 | 0.472 |
Clinical Variables | All (n = 163) | RV GLS ≥ −12.55 (n = 75) | RV GLS < −12.55 (n = 88) | p |
---|---|---|---|---|
1-month composite event | 29 (17.79) | 20 (26.67) | 9 (10.23) | 0.011 |
1-month pneumonia | 10 (6.13) | 6 (8.0) | 4 (4.55) | 0.515 |
1-month pulmonary oedema or effusion | 13 (7.98) | 7 (9.33) | 6 (6.82) | 0.764 |
1-month PTE | 4 (2.45) | 4 (5.33) | 0 (0.0) | 0.043 |
1-month all-cause death | 8 (4.91) | 6 (8.0) | 2 (2.27) | 0.145 |
1-year composite event | 36 (22.09) | 23 (30.67) | 13 (14.77) | 0.025 |
1-year pneumonia | 11 (6.75) | 6 (8.0) | 5 (5.68) | 0.783 |
1-year pulmonary oedema or effusion | 16 (9.82) | 9 (12.0) | 7 (7.95) | 0.548 |
1-year PTE | 4 (2.45) | 4 (5.33) | 0 (0.0) | 0.043 |
1-year all-cause death | 12 (7.36) | 8 (10.67) | 4 (4.55) | 0.228 |
Univariate | Multivariate | |||||
---|---|---|---|---|---|---|
HR | 95% CI | p | HR | 95% CI | p | |
RV GLS ≥ −12.55% | 2.80 | 1.388–5.648 | 0.004 | 2.65 | 1.225–5.710 | 0.013 |
Atrial fibrillation | 3.62 | 1.338–9.769 | 0.011 | 1.92 | 0.622–5.916 | 0.256 |
BMI ≥ 25 kg/m2 | 2.80 | 1.416–5.531 | 0.003 | 3.90 | 1.858–8.182 | <0.001 |
Na, mmol/L | 0.95 | 0.903–0.999 | 0.044 | 0.92 | 0.869–0.984 | 0.014 |
BNP, pg/mL | 1.00 | 0.999–1.001 | 0.070 | 1.00 | 0.999–1.001 | 0.657 |
CRP, mg/dL | 1.04 | 0.999–1.085 | 0.053 | 1.04 | 0.990–1.095 | 0.116 |
RVESVi, mL/m2 | 1.03 | 1.000–1.061 | 0.046 | 1.04 | 01.004–1.071 | 0.026 |
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Kim, H.-J.; Kim, H.-S.; Heo, J.-H. Right Ventricular Subclinical Dysfunction as a Predictor of Postoperative Adverse Clinical Outcomes in Patients with Femoral Fracture. J. Pers. Med. 2024, 14, 673. https://doi.org/10.3390/jpm14070673
Kim H-J, Kim H-S, Heo J-H. Right Ventricular Subclinical Dysfunction as a Predictor of Postoperative Adverse Clinical Outcomes in Patients with Femoral Fracture. Journal of Personalized Medicine. 2024; 14(7):673. https://doi.org/10.3390/jpm14070673
Chicago/Turabian StyleKim, Hyun-Jin, Hyun-Sun Kim, and Jeong-Heon Heo. 2024. "Right Ventricular Subclinical Dysfunction as a Predictor of Postoperative Adverse Clinical Outcomes in Patients with Femoral Fracture" Journal of Personalized Medicine 14, no. 7: 673. https://doi.org/10.3390/jpm14070673