Korshin A, Grønlykke L, Nilsson J C, Møller-Sørensen H, Ihlemann N, Kjøller M, Damgaard S, Lehnert P, Hassager C, Kjaergaard J, Ravn H B
Department of Cardiothoracic Anaesthesia and Intensive Care, The Heart Centre, Rigshospitalet, Copenhagen, Denmark.
Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark.
Int J Cardiovasc Imaging. 2018 Jul;34(7):1017-1028. doi: 10.1007/s10554-018-1306-4. Epub 2018 Jan 30.
Tricuspid annular plane systolic excursion (TAPSE) is a robust measure of RV function, but the performance of transesophageal echocardiography (TEE) measured TAPSE during surgery is not well established. We aim to evaluate feasibility of various TEE views before, during and after surgery. Furthermore, we compare performance of individual TEE measurements depending on view and method (AMM- and M-mode as well as 2D) as well as TAPSE measured using TEE with transthoracic echocardiography (TTE) TAPSE. The study was conducted from January 2015 through September 2016. In 47 patients with normal left ventricular ejection fraction, TEE was prospectively performed during coronary artery bypass grafting surgery. TAPSE and tricuspid annulus tissue Doppler imaging (TDI) were recorded in five different views at pre-specified time points during surgery. Data were analyzed for availability (obtainable/readable images) and reliability (intra-/inter-observer bias and precision). Finally, TEE TAPSE was compared to TTE TAPSE immediately before and after surgery. TAPSE and TDI with TEE was achievable in > 90% of patients in the transgastric view during surgery. The AM- and M-mode had the best reliability and the best correlation with TAPSE measured with TTE. The deep transgastric view was achievable in less than 50% after sternotomy, and TAPSE measured from 2D had a poorer performance compared to the AM- and M-mode. TDI demonstrated a high reliability throughout surgery. RV function can be evaluated by TAPSE and TDI using TEE during surgery. TEE values from the transgastric view demonstrated high performance throughout surgery and a good agreement with TTE TAPSE measurements.
三尖瓣环平面收缩期位移（TAPSE）是评估右心室功能的可靠指标，但经食管超声心动图（TEE）在手术期间测量TAPSE的效果尚未完全明确。我们旨在评估手术前、手术期间和手术后各种TEE视图的可行性。此外，我们比较了根据视图和方法（AMM和M模式以及二维）进行的个体TEE测量的性能，以及使用TEE测量的TAPSE与经胸超声心动图（TTE）测量的TAPSE。该研究于2015年1月至2016年9月进行。对47例左心室射血分数正常的患者，在冠状动脉旁路移植手术期间前瞻性地进行TEE检查。在手术期间预先指定的时间点，于五个不同视图记录TAPSE和三尖瓣环组织多普勒成像（TDI）。分析数据的可用性（可获得/可读图像）和可靠性（观察者内/间偏差和精度）。最后，在手术前后立即将TEE测量的TAPSE与TTE测量的TAPSE进行比较。手术期间，在经胃视图中，超过90%的患者可实现TEE测量的TAPSE和TDI。AM和M模式具有最佳的可靠性，且与TTE测量的TAPSE相关性最佳。胸骨切开术后，不到50%的患者可获得深经胃视图，与AM和M模式相比，二维测量的TAPSE性能较差。TDI在整个手术过程中显示出高可靠性。手术期间可通过TEE使用TAPSE和TDI评估右心室功能。经胃视图的TEE值在整个手术过程中表现良好，且与TTE测量的TAPSE测量值具有良好的一致性。
