Agreement Between Transesophageal Echocardiographic Tricuspid Annular Plane Systolic Excursion Measurement Methods in Cardiac Surgery Patients

Abstract

Objective: To assess the agreement between 2-dimensional tricuspid annular plane systolic excursion (2D-TAPSE), 2D-TAPSE-apex, and 2D speckle tracking echocardiography (STE-TAPSE) in a cross-section of routine cardiac surgery patients.

Design: Retrospective, observational study.

Setting: Tertiary, academic referral hospital.

Participants: Patients undergoing elective cardiac surgery with intraoperative transesophageal echocardiography (TEE) imaging.

Interventions: TEE imaging was reviewed and evaluated for the following three different measurements of transthoracic echocardiography-TAPSE surrogates: 2D-TAPSE, 2D-TAPSE-apex, and STE-TAPSE. Statistical analyses, including 2-sample t tests, linear regression, and agreement using the Bland-Altman methods, were performed.

Measurements and main results: Modest correlation was demonstrated between STE-TAPSE and 2D-TAPSE (R² = 0.37; p < 0.001) and between STE-TAPSE and 2D-TAPSE-apex (R² = 0.34; p < 0.001). There was good correlation between 2D-TAPSE and 2D-TAPSE-apex (R² = 0.77, p < 0.001). The Bland-Altman analysis between these methods showed minimal bias: STE-TAPSE and 2D-TAPSE 0.84 mm, STE-TAPSE and 2D-TAPSE-apex 0.14 mm, and 2D-TAPSE and 2D-TAPSE-apex 0.98 mm. However, the agreement was poor, with 95% limits of agreement of -10.67 to 8.99 mm, -10.67 to 10.96 mm, and -4.91 to 6.88 mm, respectively.

Conclusions: Correlation and minimal bias were found between the several proposed TEE surrogates of transthoracic echocardiography-TAPSE; however, there was poor agreement. Therefore, these surrogates are not interchangeable, and each method needs to be separately validated for clinical use to relevant perioperative outcomes.

Keywords: cardiac anesthesia; intraoperative echocardiography; right ventricular function; speckle tracking; transesophageal echocardiography; tricuspid annular plane systolic excursion.