Transesophageal Speckle-Tracking Echocardiography Improves Right Ventricular Systolic Function Assessment in the Perioperative Setting

Markin, Nicholas W.; Chamsi-Pasha, Mohammed A.; Luo, Jiangtao; Thomas, Walker R.; Brakke, Tara R.; Porter, Thomas R.; Shillcutt, Sasha K.

doi:10.1016/j.echo.2016.10.002

Cited by 39 publications

(17 citation statements)

References 24 publications

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“…Our study suggests that TAD DTI significantly underestimates TAPSE. 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.…”

Section: Discussionmentioning

confidence: 80%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Background: Tricuspid annular plane systolic excursion (TAPSE) is a recommended quantitative measure of right ventricular (RV) longitudinal function assessed by Mmode echocardiography. Offline alternatives are desirable when TAPSE is unavailable. This study aimed to assess the feasibility, reliability, and agreement between retrospectively obtained measures of tricuspid annular displacement using Doppler tissue imaging (TAD DTI ) and speckle tracking echocardiography (TAD STE ) compared with reference TAPSE.Methods: Consecutive subjects referred for evaluation of heart failure were enrolled.Subjects in atrial fibrillation, significant valvular disease, or with poor image quality were excluded. TAPSE was measured during the examination using M-mode. TAD STE was measured as the maximal longitudinal displacement of the RV basal segment in systole using speckle strain imaging. TAD DTI was derived offline from color-DTI superimposed grayscale images.Results: 107 subjects (age 60 ± 16; 48% female) were analyzed. Both TAD DTI and TAD STE demonstrated good feasibility and excellent intra-and inter-observer concordances. Although both measures demonstrated strong association with TAPSE, TAD DTI showcased lower specificity to identify RV dysfunction and higher false positives. Bland-Altman analysis revealed a tendency of TAD DTI to underestimate TAPSE (bias = 1.40; SD = 2.74 mm) as compared with TAD STE (bias = 0.27; SD = 2.30mm).Wide limits of agreement were observed for both methods.Conclusions: TAD STE and TAD DTI provide reproducible and feasible quantification of RV function. However, TAD DTI significantly underestimates TAPSE limiting the interchangeability of these modalities. K E Y W O R D S motion-mode echocardiography, myocardial mechanics, tricuspid annular plane systolic excursion | 2005 TAN eT Al.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…22 Furthermore, recent publications suggested the use of non-strain applications of speckle tracking RV analysis to be more useful when correlating to the TTE standard evaluation of RV function. 9 Overall, while speckle tracking and strain remain hopeful new candidates for utility in intra-operative assessment, considerable validation work for normalized values and comparisons with other echocardiographic modalities remains. 23 …”

Section: Discussionmentioning

confidence: 99%

“…8 When compared to TTE M-mode, speckle tracking TAPSE may more accurately compare than TEE M-mode derived TAPSE. 9 The alignment of cardiac motion with the doppler interrogation angle can be a major limitation in addition to the far field position of the RV relative to the esophagus when using doppler modalities. The geometric shape of the RV also limits many of the modalities that have been useful for LV function analysis.…”

Section: Introductionmentioning

confidence: 99%

Right Ventricular Longitudinal Strain In Left Ventricular Assist Device Surgery–A Retrospective Cohort Study

Beck

Foley

Rowe

et al. 2017

Journal of Cardiothoracic and Vascular Anesthesia

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Objectives Right ventricular (RV) failure is common after left ventricular assist device (LVAD) surgery and is associated with higher mortality. Measurement of longitudinal RV strain using speckle-tracking technology is a novel approach to quantify RV function. We hypothesized that depressed peak longitudinal RV strain measured by intraoperative transesophageal echocardiography (TEE) examinations would be associated with adverse outcomes after LVAD surgery. Design Retrospective Cohort Study. Setting Tertiary academic medical center. Participants Following IRB approval, we retrospectively identified adult patients that underwent implantation of non-pulsatile LVAD. Exclusion criteria included: inadequate TEE images and device explantation within six months for heart transplantation. Interventions None. Measurements and Main Results The postoperative adverse event outcome was defined as a composite of one or more of death within six months, ≥14 days of inotropes, mechanical RV support, or device thrombosis. Intraoperative TEE images were analyzed for peak RV free wall longitudinal strain by two blinded investigators. Simple logistic regression was used to assess the relationship between adverse outcome and the mean of the strain measurements of the two raters. Agreement between the raters was assessed by intra-class correlation (0.62) and Pearson correlation coefficient (0.63). Of the 57 subjects, 21 (37%) had an adverse outcome. The logistic regression indicated no significant association between RV peak longitudinal strain and adverse events. Conclusions In this retrospective study of patients undergoing non-pulsatile LVAD implantation, peak longitudinal strain of the RV free wall was not associated with adverse outcomes within six months after surgery. Additional quantitative echocardiographic measures for intraoperative RV assessment should be explored.

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“…These regional, 1-dimensional measurements have limited accuracy with TEE because of angle dependency and the position of the probe behind the left atrium. 5 Fractional area change (FAC) is a two-dimensional (2D) estimation of RV ejection fraction (EF) but still is a regional measurement because it is based on a single cross-section of the right ventricle in a 4-chamber view.…”

mentioning

confidence: 99%

Regional Versus Global Measurements of Right Ventricular Strain Performed in the Operating Room With Transesophageal Echocardiography

Silverton

Lee

Morrissey

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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Transesophageal Speckle-Tracking Echocardiography Improves Right Ventricular Systolic Function Assessment in the Perioperative Setting

Cited by 39 publications

References 24 publications

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

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

Right Ventricular Longitudinal Strain In Left Ventricular Assist Device Surgery–A Retrospective Cohort Study

Regional Versus Global Measurements of Right Ventricular Strain Performed in the Operating Room With Transesophageal Echocardiography

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