Advertisement

The International Journal of Cardiovascular Imaging

, Volume 35, Issue 12, pp 2177–2188 | Cite as

Novel mesh-derived right ventricular free wall longitudinal strain analysis by intraoperative three-dimensional transoesophageal speckle-tracking echocardiography: a comparison with conventional parameters

  • Marius KellerEmail author
  • Tobias Lang
  • Andreas Schilling
  • Martina Nowak-Machen
  • Peter Rosenberger
  • Harry Magunia
Original Paper

Abstract

Longitudinal right ventricular (RV) function is substantial and might be reflected by free wall longitudinal strain (FWLS). Software solutions for FWLS analysis by two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) are available, but data on validation are sparse. In this study, a novel method for FWLS analysis on 3D meshes (“mesh surface”, MS-FWLS,) was tested for feasibility and compared to available parameters. 80 patients undergoing left-sided cardiac valve surgery with intraoperative TEE were included retrospectively. 2D-FWLS, 3D-derived (3Dd)-FWLS (assessed in optimized four-chamber views after volume analysis) and MS-FWLS were measured and compared to conventional parameters (3Dd-TAPSE, FAC and RVEF). The mean FWLS values did not differ significantly between methods (− 19.0 ± 6.1%, − 20.0 ± 7.3%, − 19.5 ± 7.3% for 2D-, 3Dd- and MS-FWLS, respectively). No significant differences in the mean FWLS between patients with normal or increased pulmonary artery pressures as well as normal or reduced left ventricular ejection fraction were observed. Agreement was best between 3Dd- and MS-FWLS (r = 0.89, bias = − 1.0%, LOA ± 6.9%). Conventional echocardiographic parameters yielded poorer intermodality agreement. In patients with discrepant results between 2D- and 3Dd-FWLS, 3Dd-FWLS and MS-FWLS yielded similar results (r = 0.82, bias = − 0.3%, LOA ± 8.6%), while 2D-FWLS and MS-FWLS did not. Intra- and interobserver variabilities of strain analyses were low. MS-FWLS might represent a promising method to overcome artefacts associated with 2D analysis. Its prognostic relevance needs to be investigated in prospective studies.

Keywords

Right ventricle Free wall strain Transesopheageal echocardiography Speckle-tracking Three-dimensional 

Abbreviations

2D-FWLS

2D free wall longitudinal strain

3Dd-FWLS

3D-derived free wall longitudinal strain

3Dd-TAPSE

3D-derived tricuspid annular plane systolic excursion

4CH

FOUR-chamber view

ED

end-diastole

ES

End-systole

etCO2

End-tidal carbon dioxide

FAC

Fractional area change

FiO2

Fraction of inspired oxygen

FWd

End-diastolic right ventricular free wall thickness

FWLS

Free wall longitudinal strain

ICC

Intraclass correlation coefficient

LV

Left ventricle/left ventricular

LVEF

Left ventricular ejection fraction

MAP

Mean arterial pressure

mmHg

Millimetre of mercury

FWLS

Mesh surface free wall longitudinal strain

ns

Not (statistically) significant

NYHA

New York Heart Association

PAPsys

Systolic pulmonary artery pressure

ROI

Region of interest

RV

Right ventricle/right ventricular

RVEDV

Right ventricular end-diastolic volume

RVEF

Right ventricular ejection fraction

RVESV

Right ventricular end-systolic volume

STE

Speckle-tracking echocardiography

STROBE

Strengthening the Reporting of Observational Studies in Epidemiology

TAPSE

Tricuspid annular plane systolic excursion

TEE

Transoesophageal echocardiography

TTE

Transthoracic echocardiography

Notes

Acknowledgements

The authors thank all employees of the cardiothoracic and cardiac anaesthesia units at University Hospital Tuebingen for supporting image acquisition.

Funding

This work was supported by a grant from the Deutsche Forschungsgemeinschaft (DFG): Grant DFG-INST 2388/71-1 FUGG.

Compliance with ethical standards

Conflict of interest

All authors (Marius Keller, Tobias Lang, Andreas Schilling, Martina Nowak-Machen, Peter Rosenberger and Harry Magunia) declare that they have no conflicts of interest.

References

  1. 1.
    Ternacle J, Berry M, Cognet T, Kloeckner M et al (2013) Prognostic value of right ventricular two-dimensional global strain in patients referred for cardiac surgery. J Am Soc Echocardiogr. 267:721–726.  https://doi.org/10.1016/j.echo.2013.03.021 CrossRefGoogle Scholar
  2. 2.
    Longobardo L, Suma V, Jain R, Carerj S et al (2017) Role of two-dimensional speckle-tracking echocardiography strain in the assessment of right ventricular systolic function and comparison with conventional parameters. J Am Soc Echocardiogr 3010(937–946):e6.  https://doi.org/10.1016/j.echo.2017.06.016 CrossRefGoogle Scholar
  3. 3.
    Geyer H, Caracciolo G, Abe H, Wilansky S et al (2010) Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. J Am Soc Echocardiogr 234:351–369.  https://doi.org/10.1016/j.echo.2010.02.015 CrossRefGoogle Scholar
  4. 4.
    Lang RM, Badano LP, Mor-Avi V, Afilalo J et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 281(1–39):e14.  https://doi.org/10.1016/j.echo.2014.10.003 CrossRefGoogle Scholar
  5. 5.
    Ishizu T, Seo Y, Atsumi A, Tanaka YO et al (2017) Global and regional right ventricular function assessed by novel three-dimensional speckle-tracking echocardiography. J Am Soc Echocardiogr 3012:1203–1213.  https://doi.org/10.1016/j.echo.2017.08.007 CrossRefGoogle Scholar
  6. 6.
    Eltzschig HK, Rosenberger P, Loffler M, Fox JA et al (2008) Impact of intraoperative transesophageal echocardiography on surgical decisions in 12,566 patients undergoing cardiac surgery. Ann Thorac Surg 853:845–852.  https://doi.org/10.1016/j.athoracsur.2007.11.015 CrossRefGoogle Scholar
  7. 7.
    Magunia H, Dietrich C, Langer HF, Schibilsky D et al (2018) 3D echocardiography derived right ventricular function is associated with right ventricular failure and mid-term survival after left ventricular assist device implantation. Int J Cardiol.  https://doi.org/10.1016/j.ijcard.2018.06.02610.1016/j.ijcard.2018.06.026.CrossRefPubMedGoogle Scholar
  8. 8.
    Magunia H, Schmid E, Hilberath JN, Haberle L et al (2017) 2D Echocardiographic evaluation of right ventricular function correlates with 3D volumetric models in cardiac surgery patients. J Cardiothorac Vasc Anesth 312:595–601.  https://doi.org/10.1053/j.jvca.2016.11.020 CrossRefGoogle Scholar
  9. 9.
    Lang RM, Badano LP, Tsang W, Adams DH et al (2012) EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr 251:3–46.  https://doi.org/10.1016/j.echo.2011.11.010 CrossRefGoogle Scholar
  10. 10.
    Hahn RT, Abraham T, Adams MS, Bruce CJ et al (2013) Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 269:921–964.  https://doi.org/10.1016/j.echo.2013.07.009 CrossRefGoogle Scholar
  11. 11.
    von Elm E, Altman DG, Egger M, Pocock SJ et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 3709596:1453–1457.  https://doi.org/10.1016/s0140-6736(07)61602-x CrossRefGoogle Scholar
  12. 12.
    Wu VC, Takeuchi M, Otani K, Haruki N et al (2013) Effect of through-plane and twisting motion on left ventricular strain calculation: direct comparison between two-dimensional and three-dimensional speckle-tracking echocardiography. J Am Soc Echocardiogr 2611:1274–1281.e4.  https://doi.org/10.1016/j.echo.2013.07.006 CrossRefGoogle Scholar
  13. 13.
    Jacobs LD, Salgo IS, Goonewardena S, Weinert L et al (2006) Rapid online quantification of left ventricular volume from real-time three-dimensional echocardiographic data. Eur Heart J 274:460–468.  https://doi.org/10.1093/eurheartj/ehi666 CrossRefGoogle Scholar
  14. 14.
    Negishi K, Negishi T, Agler DA, Plana JC et al (2012) Role of temporal resolution in selection of the appropriate strain technique for evaluation of subclinical myocardial dysfunction. Echocardiography 293:334–339.  https://doi.org/10.1111/j.1540-8175.2011.01586.x CrossRefGoogle Scholar
  15. 15.
    Yodwut C, Weinert L, Klas B, Lang RM et al (2012) Effects of frame rate on three-dimensional speckle-tracking-based measurements of myocardial deformation. J Am Soc Echocardiogr 259:978–985.  https://doi.org/10.1016/j.echo.2012.06.001 CrossRefGoogle Scholar
  16. 16.
    Lakatos B, Tősér Z, Tokodi M, Doronina A et al (2017) Quantification of the relative contribution of the different right ventricular wall motion components to right ventricular ejection fraction: the revision method. Cardiovasc Ultrasound 15:8.  https://doi.org/10.1186/s12947-017-0100-0 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Lu KJ, Chen JX, Profitis K, Kearney LG et al (2015) Right ventricular global longitudinal strain is an independent predictor of right ventricular function: a multimodality study of cardiac magnetic resonance imaging, real time three-dimensional echocardiography and speckle tracking echocardiography. Echocardiography 326:966–974.  https://doi.org/10.1111/echo.12783 CrossRefGoogle Scholar
  18. 18.
    Korshin A, Grønlykke L, Nilsson JC, Møller-Sørensen H et al (2018) The feasibility of tricuspid annular plane systolic excursion performed by transesophageal echocardiography throughout heart surgery and its interchangeability with transthoracic echocardiography. Int J Cardiovasc Imaging 347:1017–1028.  https://doi.org/10.1007/s10554-018-1306-4 CrossRefGoogle Scholar
  19. 19.
    Morita Y, Nomoto K, Fischer GW (2016) Modified tricuspid annular plane systolic excursion using transesophageal echocardiography for assessment of right ventricular function. J Cardiothorac Vasc Anesth. 301:122–126.  https://doi.org/10.1053/j.jvca.2015.07.024 CrossRefGoogle Scholar
  20. 20.
    Garcia-Martin A, Moya-Mur JL, Carbonell-San Roman SA, Garcia-Lledo A et al (2016) Four chamber right ventricular longitudinal strain versus right free wall longitudinal strain. Prognostic value in patients with left heart disease. Cardiol J 232:189–194.  https://doi.org/10.5603/CJ.a2015.0079 CrossRefGoogle Scholar
  21. 21.
    Smith BCF, Dobson G, Dawson D, Charalampopoulos A et al (2014) Three-dimensional speckle tracking of the right ventricle: toward optimal quantification of right ventricular dysfunction in pulmonary hypertension. J Am Coll Cardiol 641:41–51.  https://doi.org/10.1016/j.jacc.2014.01.084 CrossRefGoogle Scholar
  22. 22.
    Kossaify A (2015) Echocardiographic assessment of the right ventricle, from the conventional approach to speckle tracking and three-dimensional imaging, and insights into the "right way" to explore the forgotten chamber. Clin Med Insights Cardiol 9:65–75.  https://doi.org/10.4137/CMC.S27462 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Nowak-Machen M, Lang T, Schilling A, Mockenhaupt L et al (2019) Regional Right Ventricular Volume and Function Analysis Using Intraoperative 3-Dimensional Echocardiography-Derived Mesh Models. J Cardiothorac Vasc Anesth 336:1527–1532.  https://doi.org/10.1053/j.jvca.2019.02.011 CrossRefGoogle Scholar
  24. 24.
    Luo L, Zhu J, Chen J, Gao L et al (2016) Study of right ventricular function with preserved left ejection fraction by three-dimensional speckle tracking in uremic patients undergoing peritoneal dialysis. Int J Clin Exp Med 96:11113–11124Google Scholar
  25. 25.
    Greiner S, Heimisch M, Aurich M, Hess JA et al (2014) Multiplane two-dimensional strain echocardiography for segmental analysis of right ventricular mechanics: new-RV study. Clin Res Cardiol 10310:817–824.  https://doi.org/10.1007/s00392-014-0723-1 CrossRefGoogle Scholar
  26. 26.
    Focardi M, Cameli M, Carbone SF, Massoni A et al (2015) Traditional and innovative echocardiographic parameters for the analysis of right ventricular performance in comparison with cardiac magnetic resonance. Eur Heart J Cardiovasc Imaging 161:47–52.  https://doi.org/10.1093/ehjci/jeu156 CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Anaesthesiology and Intensive Care Medicine, University Hospital TuebingenEberhard-Karls-UniversityTuebingenGermany
  2. 2.Chair of Visual Computing, Department of Computer ScienceEberhard-Karls-UniversityTuebingenGermany
  3. 3.Institute of Anaesthesiology and Intensive Care MedicineKlinikum IngolstadtIngolstadtGermany

Personalised recommendations