Abstract
Tricuspid annular plane systolic excursion (TAPSE) is a robust measure of RV function, but the performance of transesophageal echocardiography (TEE) measured TAPSE during surgery is not well established. We aim to evaluate feasibility of various TEE views before, during and after surgery. Furthermore, we compare performance of individual TEE measurements depending on view and method (AMM- and M-mode as well as 2D) as well as TAPSE measured using TEE with transthoracic echocardiography (TTE) TAPSE. The study was conducted from January 2015 through September 2016. In 47 patients with normal left ventricular ejection fraction, TEE was prospectively performed during coronary artery bypass grafting surgery. TAPSE and tricuspid annulus tissue Doppler imaging (TDI) were recorded in five different views at pre-specified time points during surgery. Data were analyzed for availability (obtainable/readable images) and reliability (intra-/inter-observer bias and precision). Finally, TEE TAPSE was compared to TTE TAPSE immediately before and after surgery. TAPSE and TDI with TEE was achievable in > 90% of patients in the transgastric view during surgery. The AM- and M-mode had the best reliability and the best correlation with TAPSE measured with TTE. The deep transgastric view was achievable in less than 50% after sternotomy, and TAPSE measured from 2D had a poorer performance compared to the AM- and M-mode. TDI demonstrated a high reliability throughout surgery. RV function can be evaluated by TAPSE and TDI using TEE during surgery. TEE values from the transgastric view demonstrated high performance throughout surgery and a good agreement with TTE TAPSE measurements.
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References
Vlahakes GJ (2012) Right ventricular failure after cardiac surgery. Cardiol Clin 30:283–289. https://doi.org/10.1016/j.ccl.2012.03.010
Kaul S, Tei C, Hopkins JM, Shah PM (1984) Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 107:526–531
Sato T, Tsujino I, Oyama-Manabe N et al (2013) Simple prediction of right ventricular ejection fraction using tricuspid annular plane systolic excursion in pulmonary hypertension. Int J Cardiovasc Imaging 29:1799–1805. https://doi.org/10.1007/s10554-013-0286-7
Grønlykke L, Ravn HB, Gustafsson F et al (2016) Right ventricular dysfunction after cardiac surgery - diagnostic options. Scand Cardiovasc J. https://doi.org/10.1080/14017431.2016.1264621
Kjaergaard J, Petersen CL, Kjaer A et al (2006) Evaluation of right ventricular volume and function by 2D and 3D echocardiography compared to MRI. Eur J Echocardiogr 7:430–438. https://doi.org/10.1016/j.euje.2005.10.009
Hamilton-Craig CR, Stedman K, Maxwell R et al (2016) Accuracy of quantitative echocardiographic measures of right ventricular function as compared to cardiovascular magnetic resonance. IJCHA 12:38–44. https://doi.org/10.1016/j.ijcha.2016.05.007
Sato T, Tsujino I, Ohira H et al (2012) Validation study on the accuracy of echocardiographic measurements of right ventricular systolic function in pulmonary hypertension. J Am Soc Echocardiogr 25:280–286. https://doi.org/10.1016/j.echo.2011.12.012
Smith JL, Bolson EL, Wong SP et al (2003) Three-dimensional assessment of two-dimensional technique for evaluation of right ventricular function by tricuspid annulus motion. Int J Cardiovasc Imaging 19:189–197
Markin NW, Chamsi-Pasha M, Luo J et al (2016) Transesophageal speckle-tracking echocardiography improves right ventricular systolic function assessment in the perioperative setting. J Am Soc Echocardiogr. https://doi.org/10.1016/j.echo.2016.10.002
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 30:122–126. https://doi.org/10.1053/j.jvca.2015.07.024
Flo Forner A, Hasheminejad E, Sabate S et al (2017) Agreement of tricuspid annular systolic excursion measurement between transthoracic and transesophageal echocardiography in the perioperative setting. Int J Cardiovasc Imaging 26:71. https://doi.org/10.1007/s10554-017-1128-9
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310
Skinner H, Kamaruddin H, Mathew T (2016) Tricuspid annular plane systolic excursion: comparing transthoracic to transesophageal echocardiography. J Cardiothorac Vasc Anesth. https://doi.org/10.1053/j.jvca.2016.09.001
Tamborini G, Muratori M, Brusoni D et al (2009) Is right ventricular systolic function reduced after cardiac surgery? A two- and three-dimensional echocardiographic study. Eur J Echocardiogr 10:630–634. https://doi.org/10.1093/ejechocard/jep015
Olmos-Temois SG, Santos-Martínez LE, Álvarez-Álvarez R et al (2016) Interobserver agreement on the echocardiographic parameters that estimate right ventricular systolic function in the early postoperative period of cardiac surgery. Med Intensiva. https://doi.org/10.1016/j.medin.2016.02.013
Kopecna D, Briongos S, Castillo H et al (2014) Interobserver reliability of echocardiography for prognostication of normotensive patients with pulmonary embolism. Cardiovasc Ultrasound 12:29. https://doi.org/10.1186/1476-7120-12-29
de Knegt MC, Biering-Sorensen T, Sogaard P et al (2014) Concordance and reproducibility between M-mode, tissue Doppler imaging, and two-dimensional strain imaging in the assessment of mitral annular displacement and velocity in patients with various heart conditions. Eur Heart J Cardiovasc Imaging 15:62–69. https://doi.org/10.1093/ehjci/jet119
Peter Slinger MF (2011) Principles and Practice of Anesthesia for Thoracic Surgery. Springer, New York
Møller-sørensen H, Graeser K, Hansen KL et al (2013) Measurements of cardiac output obtained with transesophageal echocardiography and pulmonary artery thermodilution are not interchangeable. Acta Anaesthesiol Scand 58:80–88. https://doi.org/10.1111/aas.12227
Lang RM, Badano LP, Mor-Avi V 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 28:1–39.e14. https://doi.org/10.1016/j.echo.2014.10.003
Pinedo M, Villacorta E, Tapia C et al (2010) Inter- and intra-observer variability in the echocardiographic evaluation of right ventricular function. Rev Esp Cardiol 63:802–809
Unsworth B, Casula RP, Kyriacou A et al (2010) The right ventricular annular velocity reduction caused by coronary artery bypass graft surgery occurs at the moment of pericardial incision. Am Heart J 159:314–322. https://doi.org/10.1016/j.ahj.2009.11.013
David J-S, Tousignant CP, Bowry R (2006) Tricuspid annular velocity in patients undergoing cardiac operation using transesophageal echocardiography. J Am Soc Echocardiogr 19:329–334. https://doi.org/10.1016/j.echo.2005.09.013
Pinto FJ, Wranne B, St Goar FG et al (1992) Systemic venous flow during cardiac surgery examined by intraoperative transesophageal echocardiography. Am J Cardiol 69:387–393
Wranne B, Pinto FJ, Hammarström E et al (1991) Abnormal right heart filling after cardiac surgery: time course and mechanisms. Br Heart J 66:435–442
Fusini L, Tamborini G, Gripari P et al (2011) Feasibility of intraoperative three-dimensional transesophageal echocardiography in the evaluation of right ventricular volumes and function in patients undergoing cardiac surgery. J Am Soc Echocardiogr 24:868–877. https://doi.org/10.1016/j.echo.2011.05.002
Mitoff PR, Beauchesne L, Dick AJ et al (2012) Imaging the failing right ventricle. Curr Opin Cardiol. https://doi.org/10.1097/HCO.0b013e32834fec4e
Rösner A, Avenarius D, Malm S et al (2015) Changes in Right Ventricular Shape and Deformation Following Coronary Artery Bypass Surgery-Insights from Echocardiography with Strain Rate and Magnetic Resonance Imaging. Echocardiography 32:1809–1820. https://doi.org/10.1111/echo.12973
Grønlykke L, Ihlemann N, Ngo AT et al (2016) Measures of right ventricular function after transcatheter versus surgical aortic valve replacement. Interact Cardiovasc Thorac Surg. https://doi.org/10.1093/icvts/ivw350
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All data handling was performed in accordance with Danish law and was approved by the Danish Data Protection Agency (journal # 2012-58-0004 RH-2017-78, I-Suite #: 05350) and the Danish Patient Safety Authority.
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The Danish Capital Region Regional Ethics Committee waived the need for informed consent because participation in the study was considered non-jurisdictional because the study qualified as quality assurance (protocol# H-4-2014-FSP).
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Korshin, A., Grønlykke, L., Nilsson, J.C. et al. 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, 1017–1028 (2018). https://doi.org/10.1007/s10554-018-1306-4
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DOI: https://doi.org/10.1007/s10554-018-1306-4