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Observational Study
. 2020 May;34(5):1252-1259.
doi: 10.1053/j.jvca.2019.11.039. Epub 2019 Dec 6.

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

Shayne Michael Roberts  1 , John Klick  2 , Adrian Fischl  2 , Tonya S King  3 , Theodore J Cios  2
Affiliations
Observational Study

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

Shayne Michael Roberts et al. J Cardiothorac Vasc Anesth. 2020 May.

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.

Keywords: right ventricle; right ventricular function; transesophageal echocardiography; transthoracic echocardiography.

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Conflict of interest statement

Conflict of Interest There are no conflicts of interest for any of the authors.

Figures

Figure 1:
Figure 1:
FAC measurements using the TTE apical four-chamber view measuring end-diastolic area (EDA) (A) and end-systolic area (ESA) (B) compared to the TEE four-chamber view showing EDA (C) and ESA (D) with their respective FAC calculations, all in the same patient.
Figure 2:
Figure 2:
Comparison of TAPSE methodologies using TTE apical four-chamber view (A), TEE four-chamber view using AMM (B), and the TEE TG RV inflow view (C).
Figure 3:
Figure 3:
Scatter plots illustrating the relationship between TTE (y-axis) and TEE (x-axis) for each measure of RV function: (A) AMM TAPSE; (B) Transgastric TAPSE; (C) FAC; (D) RIMP (unitless measure); (E) S’; (F) Tricuspid annulus.
See this image and copyright information in PMC

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