Echocardiographic Correlates of Pressure-Volume-Derived Indices: Advancing Intraoperative Assessment of Right Ventricular Function

This prospective observational study investigated the relationship between intraoperative three-dimensional (3D) echocardiographic parameters and invasively derived right ventricular-pulmonary arterial (RV-PA) coupling (Ees/Ea) in 78 cardiac surgery patients. Utilizing single-beat pressure-volume analysis, the authors found that 3D ejection fraction (EF) and 4D-derived fractional area change (FAC) strongly correlated with Ees/Ea (ρ=0.94 and 0.71, respectively), while longitudinal metrics such as tricuspid annular plane systolic excursion (TAPSE) did not. Specifically, a 3D EF cutoff of less than 44.2 percent effectively identified impaired coupling (AUC=0.94), which independently predicted a nearly 10-fold increased risk of prolonged postoperative vasopressor support. The authors thus concluded that 3D volumetric indices serve as reliable, practical surrogates for invasive RV-PA assessment, enabling enhanced perioperative risk stratification.