Transesophageal Speckle-Tracking Echocardiography Improves Right Ventricular Systolic Function Assessment in the Perioperative Setting

Nicholas W Markin; Mohammed Chamsi-Pasha; Jiangtao Luo; Walker R Thomas; Tara R Brakke; Thomas R Porter; Sasha K Shillcutt

doi:10.1016/j.echo.2016.10.002

Transesophageal Speckle-Tracking Echocardiography Improves Right Ventricular Systolic Function Assessment in the Perioperative Setting

J Am Soc Echocardiogr. 2017 Feb;30(2):180-188. doi: 10.1016/j.echo.2016.10.002. Epub 2016 Dec 1.

Authors

Nicholas W Markin¹, Mohammed Chamsi-Pasha², Jiangtao Luo³, Walker R Thomas⁴, Tara R Brakke⁴, Thomas R Porter², Sasha K Shillcutt⁴

Affiliations

¹ Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: nmarkin@unmc.edu.
² Section of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
³ Division of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
⁴ Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska.

PMID: 27916237
DOI: 10.1016/j.echo.2016.10.002

Abstract

Background: Perioperative evaluation of right ventricular (RV) systolic function is important to follow intraoperative changes, but it is often not possible to assess with transthoracic echocardiographic (TTE) imaging, because of surgical field constraints. Echocardiographic RV quantification is most commonly performed using tricuspid annular plane systolic excursion (TAPSE), but it is not clear whether this method works with transesophageal echocardiographic (TEE) imaging. This study was performed to evaluate the relationship between TTE and TEE TAPSE distances measured with M-mode imaging and in comparison with speckle-tracking TTE and TEE measurements.

Methods: Prospective observational TTE and TEE imaging was performed during elective cardiac surgical procedures in 100 subjects. Speckle-tracking echocardiographic TAPSE distances were determined and compared with the TTE M-mode TAPSE standard. Both an experienced and an inexperienced user of the speckle-tracking echocardiographic software evaluated the images, to enable interobserver assessment in 84 subjects.

Results: The comparison between TTE M-mode TAPSE and TEE M-mode TAPSE demonstrated significant variability, with a Spearman correlation of 0.5 and a mean variance in measurement of 6.5 mm. There was equivalence within data pairs and correlations between TTE M-mode TAPSE and both speckle-tracking TTE and speckle-tracking TEE TAPSE, with Spearman correlations of 0.65 and 0.65, respectively. The average variance in measurement was 0.6 mm for speckle-tracking TTE TAPSE and 1.5 mm for speckle-tracking TEE TAPSE.

Conclusions: Using TTE M-mode TAPSE as a control, TEE M-mode TAPSE results are not accurate and should not be used clinically to evaluate RV systolic function. The relationship between speckle-tracking echocardiographic TAPSE and TTE M-mode TAPSE suggests that in the perioperative setting, speckle-tracking TEE TAPSE might be used to quantitatively evaluate RV systolic function in the absence of TTE imaging.

Keywords: Right ventricular function quantification; Speckle-tracking echocardiography; Transesophageal echocardiography; Transthoracic echocardiography.

Publication types

Comparative Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Echocardiography, Transesophageal / methods*
Elasticity Imaging Techniques / methods*
Female
Humans
Image Enhancement / methods*
Image Interpretation, Computer-Assisted / methods
Male
Middle Aged
Observer Variation
Perioperative Care / methods*
Postoperative Complications / diagnostic imaging*
Prospective Studies
Reproducibility of Results
Sensitivity and Specificity
Ventricular Dysfunction, Right / diagnostic imaging*