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

Roberts, S. Michael; Klick, John; Fischl, Adrian; King, Tonya S.; Cios, Theodore J.

doi:10.1053/j.jvca.2019.11.039

Cited by 14 publications

(17 citation statements)

References 26 publications

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“…Thus, we did also not attempt to obtain area measurements on TTE. An option would have been the use of transesophageal echocardiography in this subpopulation, although extrapolation of TTE derived normal values is subject to uncertainty ( 7 ). Coagulopathy and thrombocytopenia are considered relative contraindications to transesophageal echocardiography ( 38 ), but small cohorts show a reasonable safety profile in patients anticoagulated for ECMO ( 39 ).…”

Section: Discussionmentioning

confidence: 99%

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

Vogel

Falvo

Powell-Tuck

et al. 2021

Critical Care Explorations

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Objectives: Changes in right ventricular size and function are frequently observed in patients with severe acute respiratory distress syndrome. The majority of patients who receive venovenous extracorporeal membrane oxygenation undergo chest CT and transthoracic echocardiography. The aims of this study were to compare the use of CT and transthoracic echocardiography to evaluate the right ventricular function and to determine the prevalence of acute cor pulmonale in this patient population. Design: Observational, retrospective, single-center, cohort study. Setting: Severe respiratory failure and extracorporeal membrane oxygenation center. Patients: About 107 patients with severe acute respiratory distress syndrome managed with venovenous extracorporeal membrane oxygenation. Interventions: Chest CT to evaluate right ventricular size and transthoracic echocardiography to evaluate right ventricular size and function. Measurements and Main Results: All 107 patients had a qualitative assessment of right ventricular size and function on transthoracic echocardiography. Quantitative measurements were available in 54 patients (50%) who underwent transthoracic echocardiography and in 107 of patients (100%) who received CT. Right ventricular dilatation was defined as a right ventricle end-diastolic diameter greater than left ventricular end-diastolic diameter upon visual assessment or an right ventricle end-diastolic diameter/left ventricular end-diastolic diameter and/or right ventricle cavity area/left ventricular cavity area of greater than 0.9. Right ventricle systolic function was visually estimated as being normal or impaired (visual right ventricular systolic impairment). The right ventricle was found to be dilated in 38/107 patients (36%) and in 58/107 patients (54%), using transthoracic echocardiography or CT right ventricle end-diastolic diameter/left ventricular end-diastolic diameter, respectively. When the CT right ventricle cavity/left ventricular cavity area criterion was used, the right ventricle was dilated in 19/107 patients (18%). About 33/107 patients (31%) exhibited visual right ventricular systolic impairment. Transthoracic echocardiography right ventricle end-diastolic diameter/left ventricular end-diastolic diameter showed good agreement with CT right ventricle cavity/left ventricular cavity area (R 2 = 0.57; p < 0.01). A CT right ventricle cavity/left ventricular cavity area greater than 0.9 provided the optimal cutoff for acute cor pulmonale on transthoracic echocardiography with an AUC of 0.78. Acute cor pulmonale was defined by the presence of a right ventricle “D-shape” and quantitative right ventricle dilatation on transthoracic echocardiography or a right ventricle cavity/left ventricular cavity area greater than 0.9 on CT. A diagnosis of acute cor pulmonale was made in 9/54 (14% patients) on transthoracic echocardiography and in 19/107 (18%) on CT. Conclusions: Changes in right ventricular size and function are common in patients with severe acute respiratory distress syndrome requiring venovenous extracorporeal membrane oxygenation with up to 18% showing imaging evidence of acute cor pulmonale. A CT right ventricular cavity /left ventricular cavity area greater than 0.9 is indicative of impaired right ventricular systolic function.

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Section: Discussionmentioning

confidence: 99%

“…Most studies assessing ACP in ARDS have used transesophageal echocardiography ( 4 ). However, transthoracic echocardiography (TTE) is noninvasive and widely available, and most normal values are validated with TTE ( 3 , 7 ). It nevertheless comes with challenges of suboptimal acoustic windows in some critically ill patients ( 8 ).…”

mentioning

confidence: 99%

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

Vogel

Falvo

Powell-Tuck

et al. 2021

Critical Care Explorations

View full text Add to dashboard Cite

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“…2,3 As highlighted by a recent study by Roberts et al in the Journal of Cardiothoracic and Vascular Anesthesia, angle-dependent measures of right ventricular (RV) systolic function may differ between TTE and TEE, for which the authors question whether these measures are interchangeable. 4 Understanding the architecture and anatomy of the right ventricle is important to determine how to best assess the right ventricle and understand how it responds to disease states. 5 The right ventricle is a thin-walled, low-pressure, capacitance structure that ejects forward into the low resistance pulmonary vasculature.…”

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confidence: 99%

“…16 Roberts et al, in this issue of the journal, compared TTE assessment with TEE assessment of RV systolic function in 102 patients immediately after induction of general anesthesia under the same loading conditions. 4 In their study, TTE guidelines were followed, and global RV function was measured using RV fractional area of change and RIMP, and longitudinal function was assessed with TAPSE and S'. 4 The authors reported significant underestimation and differences in S' and TAPSE by TEE compared with TTE, whereas RV fractional area of change and RIMP were not significantly different and moderately correlated.…”

mentioning

confidence: 99%

“…4 In their study, TTE guidelines were followed, and global RV function was measured using RV fractional area of change and RIMP, and longitudinal function was assessed with TAPSE and S'. 4 The authors reported significant underestimation and differences in S' and TAPSE by TEE compared with TTE, whereas RV fractional area of change and RIMP were not significantly different and moderately correlated. The authors concluded that TTE data may not be easily extrapolated to TEE examinations.…”

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The Limitations of Using Transthoracic Echocardiographic–Derived Normative Values for Grading Intraoperative Transesophageal Echocardiography Examinations of the Right Ventricle: Are They Really Interchangeable?

Gebhardt

Asher

Maslow

2020

Journal of Cardiothoracic and Vascular Anesthesia

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

Assanangkornchai

Villeneuve

McDonald

et al. 2022

Int J Cardiovasc Imaging

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Purpose 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.Method 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).Results FAC and AMM-TAPSE measured at the mid-esophageal 4 chamber view had substantial agreement with the TTE acquired parameters (Lin's concordance correlation coe cient (CCC) = 0.76, 95%CI 0.59-0.86 and CCC = 0.85, 95%CI 0.76-0.91). S' was signi cantly 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 signi cant changes in echocardiographic parameters, there were no corresponding changes in stroke volume (SV) or pulmonary artery pulsatility index at the post-CPB period.Conclusions TEE acquired FAC and AMM-TAPSE had substantial agreement with pre-operative TTE values and no signi cant differences between the pre-CPB and post-CPB period. Systolic RV echocardiographic parameters decreased post-CPB but this was not accompanied by signi cant hemodynamic changes.

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

Cited by 14 publications

References 26 publications

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

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

The Limitations of Using Transthoracic Echocardiographic–Derived Normative Values for Grading Intraoperative Transesophageal Echocardiography Examinations of the Right Ventricle: Are They Really Interchangeable?

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

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