Roberts SM, Klick J, Fischl A, King TS, Cios TJ. A Comparison of Transesophageal to Transthoracic Echocardiographic Measures of Right Ventricular Function.
J Cardiothorac Vasc Anesth 2019;
34:1252-1259. [PMID:
31899138 DOI:
10.1053/j.jvca.2019.11.039]
[Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES
To assess the concordance between transesophageal echocardiographic (TEE) and transthoracic echocardiograpic (TTE) measures of right ventricular (RV) function using standard 2-dimensional and Doppler methods. The authors hypothesized that there would be significant disagreement in tricuspid annular plane systolic excursion (TAPSE), fractional area change, right-sided index of myocardial performance, and tricuspid annular systolic velocity (S').
DESIGN
Prospective observational.
SETTING
Cardiac operating room at a single academic medical center.
PARTICIPANTS
All adult patients undergoing elective cardiac surgery at a single tertiary care academic medical center over 6 months.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
The fractional area change, S', TAPSE, right-sided index of myocardial performance, and tricuspid annular diameter were measured with TEE and TTE to assess for concordance using the concordance correlation coefficient and paired t tests, including 95% confidence limits. The study demonstrated that quantitative measures of RV function by TEE correlate poorly with TTE measurements in close temporal proximity under similar hemodynamic conditions.
CONCLUSIONS
When performing an assessment of RV function, transesophageal echocardiographers should exercise caution when extrapolating data validated by TTE to TEE studies. Measures of RV function by TEE tend to have fair agreement to TTE measurements obtained in close temporal proximity under similar hemodynamic conditions. Most importantly, the present study showed that TAPSE and S' values obtained from the modified transgastric RV inflow view tend to have lower values than those measured with TTE. Given the propensity for underestimating measurements from the modified transgastric RV inflow view, the authors conclude that values equal to or greater than established norms for tricuspid annular motion may be used to establish normal-but not abnormal-RV function.
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