A Comparison of Transesophageal to Transthoracic Echocardiographic Measures of Right Ventricular Function

Overview

Journal J Cardiothorac Vasc Anesth

Specialties Anesthesiology
Cardiology & Vascular Diseases
Pulmonary Medicine

Date 2020 Jan 4

PMID 31899138

Citations 5

Authors

Shayne Michael Roberts

John Klick

Adrian Fischl

Tonya S King

Theodore J Cios

Affiliations

Soon will be listed here.

Abstract

Objectives: To assess the concordance between transesophageal echocardiographic (TEE) and transthoracic echocardiograpic (TTE) measures of right ventricular (RV) function using standard 2-dimensional and Doppler methods. The authors hypothesized that there would be significant disagreement in tricuspid annular plane systolic excursion (TAPSE), fractional area change, right-sided index of myocardial performance, and tricuspid annular systolic velocity (S').

Design: Prospective observational.

Setting: Cardiac operating room at a single academic medical center.

Participants: All adult patients undergoing elective cardiac surgery at a single tertiary care academic medical center over 6 months.

Interventions: None.

Measurements And Main Results: The fractional area change, S', TAPSE, right-sided index of myocardial performance, and tricuspid annular diameter were measured with TEE and TTE to assess for concordance using the concordance correlation coefficient and paired t tests, including 95% confidence limits. The study demonstrated that quantitative measures of RV function by TEE correlate poorly with TTE measurements in close temporal proximity under similar hemodynamic conditions.

Conclusions: When performing an assessment of RV function, transesophageal echocardiographers should exercise caution when extrapolating data validated by TTE to TEE studies. Measures of RV function by TEE tend to have fair agreement to TTE measurements obtained in close temporal proximity under similar hemodynamic conditions. Most importantly, the present study showed that TAPSE and S' values obtained from the modified transgastric RV inflow view tend to have lower values than those measured with TTE. Given the propensity for underestimating measurements from the modified transgastric RV inflow view, the authors conclude that values equal to or greater than established norms for tricuspid annular motion may be used to establish normal-but not abnormal-RV function.

Citing Articles

The Agreement Between Transthoracic and Transesophageal Echocardiography in the Assessment of Right Ventricular Diastolic Dysfunction Grades in Adult Patients Undergoing Cardiac Surgery: A Prospective Observational Study.

Singh N, Biswas I, Kumar B, Gaurav K, Naganur S, Aggarwal P Cureus. 2024; 16(10):e70976.

PMID: 39376976 PMC: 11457130. DOI: 10.7759/cureus.70976.

Feasibility Value of Right Ventricular Longitudinal Shortening Fraction and the Prognostic Implications in Patients With Heart Transplantation.

Ji X, Zhang Y, Xie Y, Wang W, Tan Y, Xie M J Am Heart Assoc. 2024; 13(6):e032402.

PMID: 38456455 PMC: 11009997. DOI: 10.1161/JAHA.123.032402.

Interchangeability of right ventricular longitudinal shortening fraction assessed by transthoracic and transoesophageal echocardiography in the perioperative setting: A prospective study.

Beyls C, Huette P, Vangreveninge P, Leviel F, Daumin C, Ammar B Front Cardiovasc Med. 2023; 9:1074956.

PMID: 36620637 PMC: 9816801. DOI: 10.3389/fcvm.2022.1074956.

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

Assanangkornchai N, Villeneuve V, McDonald S, Magder S, Tim D, Buithieu J Int J Cardiovasc Imaging. 2022; 39(3):555-563.

PMID: 36399180 DOI: 10.1007/s10554-022-02754-1.

Assessment of Right Ventricular Function With CT and Echocardiography in Patients With Severe Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation.

Vogel D, Fabbri A, Falvo A, Powell-Tuck J, Desai N, Vasques F Crit Care Explor. 2021; 3(2):e0345.

PMID: 33634265 PMC: 7901809. DOI: 10.1097/CCE.0000000000000345.

References

Blauwet L, Delgado-Montero A, Ryo K, Marek J, Alharethi R, Mather P . Right Ventricular Function in Peripartum Cardiomyopathy at Presentation Is Associated With Subsequent Left Ventricular Recovery and Clinical Outcomes. Circ Heart Fail. 2016; 9(5). DOI: 10.1161/CIRCHEARTFAILURE.115.002756. View

Korshin A, Gronlykke L, Nilsson J, Moller-Sorensen H, Ihlemann N, Kjoller M . 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. 2018; 34(7):1017-1028. DOI: 10.1007/s10554-018-1306-4. View

Naoum E, Schofield P, Shen T, Andrawes M, Kuo A . Agreement Between Transesophageal Echocardiographic Tricuspid Annular Plane Systolic Excursion Measurement Methods in Cardiac Surgery Patients. J Cardiothorac Vasc Anesth. 2018; 33(3):717-724. DOI: 10.1053/j.jvca.2018.11.012. View

Alhamshari Y, Alnabelsi T, Mulki R, Cepeda-Valery B, Figueredo V, Romero-Corral A . Right ventricular function measured by TAPSE in obese subjects at the time of acute myocardial infarction and 2year outcomes. Int J Cardiol. 2017; 232:181-185. DOI: 10.1016/j.ijcard.2017.01.033. View

Malinowski M, Jazwiec T, Goehler M, Quay N, Bush J, Jovinge S . Sonomicrometry-derived 3-dimensional geometry of the human tricuspid annulus. J Thorac Cardiovasc Surg. 2018; 157(4):1452-1461.e1. DOI: 10.1016/j.jtcvs.2018.08.110. View

Dreyfus J, Durand-Viel G, Raffoul R, Alkhoder S, Hvass U, Radu C . Comparison of 2-Dimensional, 3-Dimensional, and Surgical Measurements of the Tricuspid Annulus Size: Clinical Implications. Circ Cardiovasc Imaging. 2015; 8(7):e003241. DOI: 10.1161/CIRCIMAGING.114.003241. View

Meineri M, Fassl J . The Forgotten Ventricle. J Cardiothorac Vasc Anesth. 2017; 31(5):1567-1569. DOI: 10.1053/j.jvca.2017.05.033. View

Bom N, Lancee C, Honkoop J, Hugenholtz P . Ultrasonic viewer for cross-sectional analyses of moving cardiac structures. Biomed Eng. 1971; 6(11):500-3, 5. View

David J, Tousignant C, Bowry R . Tricuspid annular velocity in patients undergoing cardiac operation using transesophageal echocardiography. J Am Soc Echocardiogr. 2006; 19(3):329-34. DOI: 10.1016/j.echo.2005.09.013. View

10.

GRAMIAK R, Waag R, Simon W . Ciné ultrasound cardiography. Radiology. 1973; 107(1):175-80. DOI: 10.1148/107.1.175. View

11.

Kaul S, Tei C, Hopkins J, Shah P . Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J. 1984; 107(3):526-31. DOI: 10.1016/0002-8703(84)90095-4. View

12.

Genovese D, Mor-Avi V, Palermo C, Muraru D, Volpato V, Kruse E . Comparison Between Four-Chamber and Right Ventricular-Focused Views for the Quantitative Evaluation of Right Ventricular Size and Function. J Am Soc Echocardiogr. 2019; 32(4):484-494. DOI: 10.1016/j.echo.2018.11.014. View

13.

Lang R, Badano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L . 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. 2015; 28(1):1-39.e14. DOI: 10.1016/j.echo.2014.10.003. View

14.

Sano H, Tanaka H, Motoji Y, Fukuda Y, Sawa T, Mochizuki Y . Right ventricular function and right-heart echocardiographic response to therapy predict long-term outcome in patients with pulmonary hypertension. Can J Cardiol. 2015; 31(4):529-36. DOI: 10.1016/j.cjca.2015.01.027. View

15.

Addetia K, Muraru D, Veronesi F, Jenei C, Cavalli G, Besser S . 3-Dimensional Echocardiographic Analysis of the Tricuspid Annulus Provides New Insights Into Tricuspid Valve Geometry and Dynamics. JACC Cardiovasc Imaging. 2017; 12(3):401-412. DOI: 10.1016/j.jcmg.2017.08.022. View

16.

Guazzi M, Dixon D, Labate V, Beussink-Nelson L, Bandera F, Cuttica M . RV Contractile Function and its Coupling to Pulmonary Circulation in Heart Failure With Preserved Ejection Fraction: Stratification of Clinical Phenotypes and Outcomes. JACC Cardiovasc Imaging. 2017; 10(10 Pt B):1211-1221. DOI: 10.1016/j.jcmg.2016.12.024. View

17.

Morita Y, Nomoto K, Fischer G . Modified Tricuspid Annular Plane Systolic Excursion Using Transesophageal Echocardiography for Assessment of Right Ventricular Function. J Cardiothorac Vasc Anesth. 2015; 30(1):122-6. DOI: 10.1053/j.jvca.2015.07.024. View

18.

Griffith J, Henry W . A sector scanner for real time two-dimensional echocardiography. Circulation. 1974; 49(6):1147-52. DOI: 10.1161/01.cir.49.6.1147. View

19.

Smith M, MacPhail B, Harrison M, Lenhoff S, DeMaria A . Value and limitations of transesophageal echocardiography in determination of left ventricular volumes and ejection fraction. J Am Coll Cardiol. 1992; 19(6):1213-22. DOI: 10.1016/0735-1097(92)90327-j. View

20.

Ravis E, Theron A, Mancini J, Jaussaud N, Morera P, Chalvignac V . Severe right ventricular dysfunction is an independent predictor of pre- and post-transplant mortality among candidates for heart transplantation. Arch Cardiovasc Dis. 2017; 110(3):139-148. DOI: 10.1016/j.acvd.2016.06.002. View