Skip to main content
SpringerLink
Log in

Interchangeability of transthoracic and transesophageal echocardiographic right heart measurements in the perioperative setting and correlation with hemodynamic parameters

  • OriginalPaper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Reduction of right ventricular (RV) function after cardiac surgery has been shown to impact outcomes. Conventional indices for right ventricular dysfunction are validated using transthoracic echocardiogram (TTE) which has limited use compared to transesophageal echocardiogram (TEE) in the perioperative settings. The aim of this study was to assess the agreement of RV systolic function assessment with TEE compared to TTE and assess the association of echocardiographic parameter with hemodynamic indices of RV dysfunction. This was a single center prospective observational study in an academic institution. Fifty adult patients undergoing elective cardiac surgery were included. TTE, TEE and stroke volume measurements pre-cardiopulmonary bypass (CPB) and post-CPB were performed. The variables of interest were anatomical M-mode tricuspid annular plane systolic excursion (AMM-TAPSE), fractional area change (FAC), tricuspid annular velocity (S’) and myocardial performance index (MPI). FAC and AMM-TAPSE measured at the mid-esophageal 4 chamber view had substantial agreement with the TTE acquired parameters (Lin’s concordance correlation coefficient (CCC) = 0.76, 95%CI 0.59–0.86 and CCC = 0.85, 95%CI 0.76–0.91). S’ was significantly underestimated by TEE (CCC = 0.07, 95%CI 0.04–0.19) and MPI showed moderate agreement (CCC = 0.45 95%CI 0.19–0.65). Despite the significant changes in echocardiographic parameters, there were no corresponding changes in stroke volume (SV) or pulmonary artery pulsatility index at the post-CPB period. TEE acquired FAC and AMM-TAPSE had substantial agreement with pre-operative TTE values and no significant differences between the pre-CPB and post-CPB period. Systolic RV echocardiographic parameters decreased post-CPB but this was not accompanied by significant hemodynamic changes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Singh A, Huang X, Dai L, Wyler D, Alfirevic A, Blackstone EH et al (2020) Right ventricular function is reduced during cardiac surgery independent of procedural characteristics, reoperative status, or pericardiotomy. J Thorac Cardiovasc Surg 159(4):1430–8.e4. https://doi.org/10.1016/j.jtcvs.2019.04.035

    Article  PubMed  Google Scholar 

  2. Lella LK, Sales VL, Goldsmith Y, Chan J, Iskandir M, Gulkarov I et al (2015) Reduced right ventricular function predicts long-term cardiac re-hospitalization after cardiac surgery. PLoS ONE 10(7):e0132808. https://doi.org/10.1371/journal.pone.0132808

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Couperus LE, Delgado V, Palmen M, van Vessem ME, Braun J, Fiocco M et al (2017) Right ventricular dysfunction affects survival after surgical left ventricular restoration. J Thorac Cardiovasc Surg 153(4):845–852. https://doi.org/10.1016/j.jtcvs.2016.09.038

    Article  PubMed  Google Scholar 

  4. Maslow AD, Regan MM, Panzica P, Heindel S, Mashikian J, Comunale ME (2002) Precardiopulmonary bypass right ventricular function is associated with poor outcome after coronary artery bypass grafting in patients with severe left ventricular systolic dysfunction. Anesth Analg 95(6):1507–1518. https://doi.org/10.1097/00000539-200212000-00009

    Article  PubMed  Google Scholar 

  5. Peyrou J, Chauvel C, Pathak A, Simon M, Dehant P, Abergel E (2017) Preoperative right ventricular dysfunction is a strong predictor of 3 years survival after cardiac surgery. Clin Res Cardiol 106(9):734–742. https://doi.org/10.1007/s00392-017-1117-y

    Article  PubMed  Google Scholar 

  6. Grønlykke L, Korshin A, Holmgaard F, Kjøller SM, Gustafsson F, Nilsson JC et al (2019) Severe loss of right ventricular longitudinal contraction occurs after cardiopulmonary bypass in patients with preserved right ventricular output. Int J Cardiovasc Imaging 35(9):1661–1670. https://doi.org/10.1007/s10554-019-01616-7

    Article  PubMed  Google Scholar 

  7. Bootsma IT, de Lange F, Koopmans M, Haenen J, Boonstra PW, Symersky T et al (2017) Right ventricular function after cardiac surgery is a strong independent predictor for long-term mortality. J Cardiothorac Vasc Anesth 31(5):1656–1662. https://doi.org/10.1053/j.jvca.2017.02.008

    Article  PubMed  Google Scholar 

  8. Levy D, Laghlam D, Estagnasie P, Brusset A, Squara P, Nguyen LS (2021) Post-operative right ventricular failure after cardiac surgery: a cohort study. Front cardiovasc med. https://doi.org/10.3389/fcvm.2021.667328

    Article  PubMed  PubMed Central  Google Scholar 

  9. Vandenheuvel M, Bouchez S, Wouters P, Mauermann E (2019) Assessing right ventricular function in the perioperative setting part I: echo-based measurements. Anesthesiol Clin 37(4):675–695. https://doi.org/10.1016/j.anclin.2019.08.011

    Article  PubMed  Google Scholar 

  10. Denault AY, Haddad F, Jacobsohn E, Deschamps A (2013) Perioperative right ventricular dysfunction. Curr Opin Anaesthesiol 26(1):71–81. https://doi.org/10.1097/ACO.0b013e32835b8be2

    Article  PubMed  Google Scholar 

  11. Zaidi A, Knight DS, Augustine DX, Harkness A, Oxborough D, Pearce K et al (2020) Echocardiographic assessment of the right heart in adults: a practical guideline from the British society of echocardiography. Echo Res Pract 7(1):G19-g41. https://doi.org/10.1530/erp-19-0051

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the american society of echocardiography: endorsed by the European association of echocardiography, a registered branch of the European society of cardiology, and the Canadian society of echocardiography. J Am Soc Echocardiogr 23(7):685–713. https://doi.org/10.1016/j.echo.2010.05.010

    Article  PubMed  Google Scholar 

  13. Flo Forner A, Hasheminejad E, Sabate S, Ackermann MA, Turton EW, Ender J (2017) Agreement of tricuspid annular systolic excursion measurement between transthoracic and transesophageal echocardiography in the perioperative setting. Int J Cardiovasc Imaging 33(9):1385–1394. https://doi.org/10.1007/s10554-017-1128-9

    Article  PubMed  Google Scholar 

  14. Korshin A, Grønlykke L, Nilsson JC, Møller-Sørensen H, Ihlemann N, Kjøller M 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 34(7):1017–1028. https://doi.org/10.1007/s10554-018-1306-4

    Article  CAS  PubMed  Google Scholar 

  15. Dhawan I, Makhija N, Choudhury M, Choudhury A (2019) Modified tricuspid annular plane systolic excursion for assessment of right ventricular systolic function. J Cardiovasc Imaging 27(1):24–33. https://doi.org/10.4250/jcvi.2019.27.e8

    Article  PubMed  PubMed Central  Google Scholar 

  16. Mauermann E, Vandenheuvel M, François K, Bouchez S, Wouters P (2020) Right ventricular systolic assessment by transesophageal versus transthoracic echocardiography: displacement, velocity, and myocardial deformation. J Cardiothorac Vasc Anesth 34(8):2152–2161. https://doi.org/10.1053/j.jvca.2020.03.009

    Article  PubMed  Google Scholar 

  17. Roberts SM, Klick J, Fischl A, King TS, Cios TJ (2020) A Comparison of transesophageal to transthoracic echocardiographic measures of right ventricular function. J Cardiothorac Vasc Anesth 34(5):1252–1259. https://doi.org/10.1053/j.jvca.2019.11.039

    Article  PubMed  Google Scholar 

  18. Lee JZ, Low SW, Pasha AK, Howe CL, Lee KS, Suryanarayana PG (2018) Comparison of tricuspid annular plane systolic excursion with fractional area change for the evaluation of right ventricular systolic function: a meta-analysis. Open Heart 5(1):e000667. https://doi.org/10.1136/openhrt-2017-000667

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L 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. Eur Heart J Cardiovasc Imaging 16(3):233–271. https://doi.org/10.1093/ehjci/jev014

    Article  PubMed  Google Scholar 

  20. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174. https://doi.org/10.2307/2529310

    Article  CAS  PubMed  Google Scholar 

  21. Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15(2):155–163. https://doi.org/10.1016/j.jcm.2016.02.012

    Article  PubMed  PubMed Central  Google Scholar 

  22. R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2020.

  23. Kassambara A. rstatix: Pipe-Friendly Framework for Basic Statistical Tests. 2020.

  24. Wickham H (2016) ggplot2: Elegant Graphics for Data Analysis. Springer-Verlag, New York

    Book  Google Scholar 

  25. Tousignant CP, Bowry R, Levesque S, Denault AY (2008) Regional differences in color tissue doppler-derived measures of longitudinal right ventricular function using transesophageal and transthoracic echocardiography. J Cardiothorac Vasc Anesth 22(3):400–405. https://doi.org/10.1053/j.jvca.2007.07.014

    Article  PubMed  Google Scholar 

  26. Michaux I, Filipovic M, Skarvan K, Bolliger D, Schumann R, Bernet F et al (2011) A randomized comparison of right ventricular function after on-pump versus off-pump coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 141(2):361–367. https://doi.org/10.1016/j.jtcvs.2010.02.023

    Article  PubMed  Google Scholar 

  27. Michaux I, Filipovic M, Skarvan K, Schneiter S, Schumann R, Zerkowski HR et al (2006) Effects of on-pump versus off-pump coronary artery bypass graft surgery on right ventricular function. J Thorac Cardiovasc Surg 131(6):1281–1288. https://doi.org/10.1016/j.jtcvs.2006.01.035

    Article  PubMed  Google Scholar 

  28. Skinner H, Kamaruddin H, Mathew T (2017) Tricuspid annular plane systolic excursion: comparing transthoracic to transesophageal echocardiography. J Cardiothorac Vasc Anesth 31(2):590–594. https://doi.org/10.1053/j.jvca.2016.09.001

    Article  PubMed  Google Scholar 

  29. Michaux I, Seeberger M, Schuman R, Skarvan K, Filipovic M (2010) Feasibility of measuring myocardial performance index of the right ventricle in anesthetized patients. J Cardiothorac Vasc Anesth 24(2):270–274. https://doi.org/10.1053/j.jvca.2009.09.010

    Article  PubMed  Google Scholar 

  30. Korshin A, Grønlykke L, Nilsson JC, Møller-Sørensen H, Ihlemann N, Kjøller SM et al (2019) Tricuspid annular plane systolic excursion is significantly reduced during uncomplicated coronary artery bypass surgery: a prospective observational study. J Thorac Cardiovasc Surg 158(2):480–489. https://doi.org/10.1016/j.jtcvs.2018.09.114

    Article  PubMed  Google Scholar 

  31. Mandoli GE, Cameli M, Novo G, Agricola E, Righini FM, Santoro C et al (2019) Right ventricular function after cardiac surgery: the diagnostic and prognostic role of echocardiography. Heart Fail Rev 24(5):625–635. https://doi.org/10.1007/s10741-019-09785-2

    Article  PubMed  Google Scholar 

  32. Korshin A, Grønlykke L, Holmgaard F, Kjøller SM, Gustafsson F, Nilsson JC et al (2020) Right ventricular transverse displacement increases following cardiac surgery: possibly compensating loss in tricuspid annular plane systolic excursion (TAPSE). J Clin Monit Comput 34(6):1139–1148. https://doi.org/10.1007/s10877-020-00466-2

    Article  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanich Road, Hatyai, Songkhla, 90110, Thailand

    Nawaporn Assanangkornchai

  2. Department of Critical Care Medicine, McGill University Health Centre, Royal Victoria Hospital, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada

    Nawaporn Assanangkornchai, Sheldon Magder & Roupen Hatzakorzian

  3. Department of Anesthesia, McGill University Health Centre, Royal Victoria Hospital, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada

    Valerie Villeneuve & Roupen Hatzakorzian

  4. Department of Anesthesiology and Pain Medicine, University of Toronto, University Health Network - Toronto General Hospital, 300 Elizabeth Street, Toronto, ON, M5G 2C4, Canada

    Sarah McDonald

  5. Department of Cardiac Surgery, McGill University Health Centre, Royal Victoria Hospital, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada

    Dominique Shum Tim

  6. Department of Cardiology, McGill University Health Centre, Royal Victoria Hospital, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada

    Jean Buithieu

Authors
  1. Nawaporn Assanangkornchai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Valerie Villeneuve
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sarah McDonald
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sheldon Magder
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dominique Shum Tim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jean Buithieu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Roupen Hatzakorzian
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RH, VV, DST, SM and JB contributed to the study conception and design. Data collection was performed by RH, VV and SMD. Data analysis and writing of the first draft of the manuscript was performed by NA. All authors commented on previous versions of the manuscript and read and approved of the final manuscript.

Corresponding author

Correspondence to Roupen Hatzakorzian.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (TIFF 196154 KB)

Supplementary file2 (DOCX 18 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Assanangkornchai, N., Villeneuve, V., McDonald, S. et al. Interchangeability of transthoracic and transesophageal echocardiographic right heart measurements in the perioperative setting and correlation with hemodynamic parameters. Int J Cardiovasc Imaging 39, 555–563 (2023). https://doi.org/10.1007/s10554-022-02754-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-022-02754-1

Keywords

Search

Navigation