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Role of Right ventricular Pulmonary artery coupling in predicting adverse outcomes after coronary artery by-pass grafting surgery.
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  • Amir Mostafa,
  • Khalid Elnady M Y,
  • Basant Ashraf,
  • Mohamed Abdel Ghany
Amir Mostafa
Cairo University

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Khalid Elnady M Y
Maadi Military Hospital
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Basant Ashraf
Maadi Military Hospital
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Mohamed Abdel Ghany
Cairo University
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Abstract

Introduction: Development of right ventricular dysfunction (RVD) is associated with adverse clinical outcome in patients doing coronary artery by-pass grafting (CABG). Right ventricular-pulmonary artery (RV-PA) coupling which describes the relationship between the RV systolic function and its afterload has been recently introduced as a prognostic parameter in multiple patient groups. In this study we evaluated the prognostic role of TAPSE/PASP ratio as a surrogate for RV-PA coupling in patients undergoing CABG. Methods: RV-PA coupling was assessed using the TASPE/PASP ratio. Echocardiography was done within 48 hours pre-operative and within 72 hours post-operative. The primary endpoint included postoperative RVD and rehospitalization within 3 months. Results: Among 100 patient doing CABG, the mean age was 59 years with predominant male gender. About 2 thirds of the patients were hypertensive and more than half of them were diabetic. The mean left ventricular ejection fraction was 62% and mean RV fractional area change (FAC) was 50% with mean TAPSE 19 mm and mean TAPSE/PASP of 0.62. Post-operative RVD developed in 35% of the patients and re-hospitalization for cardiac reasons occurred in 11%. The independent predictors of development of post-operative RVD were lower TAPSE/PASP ratio, presence of diabetes mellitus and higher levels of total Cholesterol (P-value: 0.03, 0.0001, 0.0001 respectively). The independent predictors of re-hospitalization were higher triglyceride levels and lower TAPSE/PASP Ratio (P-value: 0.02 and 0.002 respectively). Conclusion: TAPSE/PASP ratio as a surrogate for RV-PA coupling is a non-invasive simple bedside tool that can be used to predict adverse clinical outcomes in patients undergoing coronary artery by-pass grafting.