Right ventricular strain as predictor of pulmonary complications in patients with femur fracture

BACKGROUND Following femur fracture, medullary fat enters the systemic circulation and altered pulmonary haemodynamics may contribute to pulmonary complications. This study evaluated the association between right ventricular (RV) function and pulmonary complications in patients with femur fracture. METHODS Patients with a femur fracture who had undergone pre-operative echocardiography that included RV peak global longitudinal strain (RV GLS) were evaluated retrospectively between March 2015 and February 2016. Pulmonary complications were defined as the development of pneumonia or pulmonary thromboembolism during the first postoperative month. RESULTS Among 78 patients, pulmonary complications developed in eight (10.3%). The RV GLS value of all patients was lower than the normal range. In addition, the RV GLS value of patients with pulmonary complications was significantly lower than that of patients without pulmonary complications. Multivariate regression analyses found that worse RV GLS values independently predicted pulmonary complications [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.047-4.151, p = 0.037]. Receiver operating characteristic curve analysis found that a RV GLS value of -14.85% was the best cut-off value to predict pulmonary complications; sensitivity: 75.0%; specificity: 62.9%. Moreover, patients with RV GLS values > -14.85% had significantly lower pulmonary complication-free survival. CONCLUSIONS In patients with femur fracture, RV GLS values could help predict pulmonary complications. Therefore, patients with RV GLS values > -14.85 should be monitored closely before and after surgery for femur fracture.