Assessment of Tricuspid Annular Motion by Speckle Tracking in Anesthetized Patients Using Transesophageal Echocardiography

Abstract

BACKGROUND: The perioperative assessment of right ventricular (RV) function remains a challenge. Tricuspid annular plane systolic excursion (TAPSE) using M-mode is a widely used measure of RV function. However, accurate alignment of the ultrasound beam with the direction of annular movement can be difficult with transesophageal echocardiography (TEE) to measure TAPSE, precluding effective use of M-mode to measure annular excursion. Tracking of specular reflectors in the myocardium may provide an angle-independent method to assess annular motion with TEE. We hypothesized that TEE speckle tracking of the lateral tricuspid annular motion represents a comparable measurement to the well-validated M-mode TAPSE on transthoracic echocardiogram (TTE), and may be considered as a reasonable alternative to TAPSE. METHODS: This is a prospective, observational cohort study. We included all patients, who were in sinus rhythm, with a preoperative TTE within 3 months of scheduled cardiac surgery that required intraoperative TEE. Tissue motion annular displacements (TMAD) of the lateral (L), septal (S), and midpoint (M) tricuspid annulus were measured (QLAB Cardiac Motion Quantification; Philips Medical, Andover, MA) after induction of general anesthesia. This was compared to the preoperative M-mode TAPSE on TTE. RESULTS: Seventy-two consecutive patients who met eligibility requirements were enrolled from September to November 2016. Twelve were excluded due to poor image quality, allowing TMAD to be analyzed in 60 patients. TMAD was analyzed offline and TMAD analysis was able to track tricuspid annular motion in all patients. The mean TMAD (L), TMAD (S), and TMAD (M) were 17.4 ± 5.2, 10.2 ± 4.8, and 14.2 ± 4.8 mm, respectively. TMAD (L) showed close correlation with M-mode TAPSE on TTE (r = 0.87, 95% confidence interval, 0.79–0.92; P < .01). All patients with a preoperative TAPSE <17 mm had a TMAD (L) <17 mm, while 71% of those with a TAPSE ≥ 17 mm had a TMAD (L) ≥ 17 mm. There was strong positive correlation between TMAD (L) and intraoperative RV fractional area change (r = 0.86, 95% confidence interval, 0.77–0.91; P < .01). Reproducibility analysis of TMAD within and across observers showed excellent correlation. CONCLUSIONS: TMAD is a quick and angle-independent method to quantitatively assess RV longitudinal function by TEE. It correlates strongly with M-mode TAPSE on TTE. Because TMAD and TAPSE were not simultaneously measured in this study, their correlation is subject to differences in loading conditions, general anesthesia, and changes in the disease process. TMAD may be easily applied in routine clinical settings and its role in the perioperative environment deserves to be further explored.

Usefulness of Right Ventricular Longitudinal Shortening Fraction to Detect Right Ventricular Dysfunction in Acute Cor Pulmonale Related to COVID-19

“…To the contrary to other studies, we found no correlation between TAPSE and TAD lat [14,30]. However, these studies assessed TAD lat and TAD sep parameters and conventional RV systolic parameters by TEE for patients in the operating theatre during surgery with different hemodynamic and ventilatory conditions than patients with ARDS [30].…”

Feasibility and accuracy of tricuspid annular displacement assessed by speckle tracking echocardiography and Doppler tissue imaging

“…Furthermore, despite strong association, TAD STE may not be interchangeable with TAPSE as stated in an earlier study, owing to the large limits of agreement between these two methods. Furthermore, the application of TAPSE cutoff values to TAD STE , as employed in certain studies, may not be accurate.…”

“…Both DTI and STE can be applied offline to measure tricuspid annular displacement in systole (TAD) and may be useful in settings where TAPSE is not available. While few studies have suggested that TAD obtained by STE (TAD STE ) may offer a feasible alternative to TAPSE, studies evaluating the accuracy of both TAD STE and TAD obtained by DTI (TAD DTI ) as compared with reference TAPSE have not been performed.…”

A comparative study between transthoracic and transesophageal echo modalities in evaluation of left ventricular deformation

“…Transthoracic 2D strain imaging has been studied extensively; there are a great number of articles in the literature describing its clinical application . [13]; however, there are a limited number of studies that investigate the relevance of 2D strain imaging during TEE examination [16, 17].…”