Background and aim .– Assessment of right ventricular (RV) function is of prognostic value in patients undergoing cardiac surgery. In recent American guidelines, 2 definitions for the diagnosis of RV dysfunction are validated: (1) peak systolic velocity during ejection period (Sa) < 10 cm/s (2) RV fractional shortening (RVFS) < 35%. The aim of our study was to assess these recent recommendations in a large non-selected cohort of patients awaiting cardiac surgery.

Methods .– Two hundred and sixty seven patients (means values of age and LVEF respectively: 69 years [33–88] and 64% [10–89]) were enrolled of which 49% were awaiting coronary artery bypass grafting and 51% valve surgery. Conventional Echocardiography was performed in all. In addition, RVFS, Sa and RV Tei index were assessed. RVFS was obtained from an apical 4-chamber view focused on the RV by tracing RV endocardium in systole and in diastole. Sa as a simple and reproducible indice was recorded by pulsed-wave tissue Doppler in an apical 4-chamber view on a narrowed sector of the tricuspid annulus and the basal RV free wall in order to obtain the highest systolic velocity. RV Tei index was obtained by the pulsed-wave tissue Doppler method in an apical 4-chamber view. The Doppler sample was placed on the tricuspid annulus and Tei index was defined as the ratio of isovolumic time divided by ejection time. Three groups were obtained. A “normal RV function” group (RVFS > 35% and Sa > 10 cm/s), an RV dysfunction group with one abnormal criterion (RVFS < 35% or Sa < 10 cm/s) and the last group defined by 2 abnormal criteria (RVFS < 35% and Sa < 10 cm/s).

Results .– According to the normal reference values of RVFS and Sa we found 218 patients with normal RV and 49 failing RV (18% of the population): 10 patients (4%) had “RV dysfunction” based on Sa < 10 cm/s, 29 patients (11%) had only RVFS < 35% while 17 patients (6%) fulfilled both criteria. Mean Tei index was 0.447 ± 0.01 in the normal RV function group, 0.558 ± 0.05 in the RV dysfunction group defined by 1 criterion, and 0.679 ± 0.07 in the RV dysfunction group defined by 2 criteria (all P < 0.05).

Conclusions .– Applying recent guidelines (RVFS < 35% or Sa < 10 cm/s or both), we found an important discrepancy in the prevalence of RV dysfunction in a large population before cardiac surgery, ranging from 4 to 18%. Therefore, the use of both measurements (Sa and RVFS) in a systematic way appears as the most accurate way of diagnosing RV dysfunction. Furthermore, our data using the RV Tei index suggest that the presence of two pathological criteria is associated with more severe RV dysfunction than when only one pathological criterion is present.