Department for Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium; Department for Anesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine, and Pain Therapy, Basel University Hospital, Basel, Switzerland.
Department for Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium.
J Cardiothorac Vasc Anesth. 2019 Oct;33(10):2636-2644. doi: 10.1053/j.jvca.2019.05.036. Epub 2019 Jun 8.
A novel speckle-tracking-based option for measuring tricuspid annular velocities in the midesophageal 4-chamber view (ME4C) was compared with velocities measured by tissue Doppler in the apical-4 chamber view (AP4C). Because this method was based on a modified speckle-tracking-based measurement of tricuspid annular plane systolic excursion (TAPSE), the authors also compared TAPSE by speckle tracking in the ME4C with TAPSE by M-mode in the AP4C. The authors hypothesized that velocities measured by speckle tracking in transesophageal echocardiography (TEE) would be similar, correlate, and agree with those measured by tissue Doppler in transthoracic echocardiography (TTE).
Prospective diagnostic study with randomization of the order of post-induction echocardiography views by TTE (AP4C) and TEE (ME4C). Images were both acquired and analyzed by 2 echocardiographers independently. The primary outcome was S'; secondary outcomes were E', A', and TAPSE.
Single university hospital.
Consecutive adult patients undergoing cardiac surgery (mainly coronary artery bypass grafting).
None.
Complete data was available in 24 of 25 patients. For the primary outcome, S' measured by speckle tracking in the ME4C correlated and agreed with S' measured by tissue Doppler in the AP4C (S' = 0.87S + 0.60, p < 0.001, r = 0.78; mean bias -0.6 cm/s, 95% limits of agreement (LoA) -3.5 to 2.4 cm/s). Similarly results were found for E', but not A' (E' = 0.69E' + 2.37, p < 0.001, r = 0.71; mean bias 0.1 cm/s, 95%LoA -2.5 to 2.8cm/s; A' = 0.15A' + 11.17, p = 0.629). TAPSE measurements by the authors' modified speckle-tracking-based technique were similar to TAPSE by M-mode (18.2 ± 5.5 mm and 17.1 ± 3.9 mm, respectively).
Tricuspid annular velocities (S', E') determined by speckle tracking in TEE seem to be promising surrogates for velocities measured in TTE. This may be important for perioperative assessment of the right ventricle.
在经食管中膈 4 腔心切面（ME4C）中，采用一种基于斑点追踪的新方法测量三尖瓣环速度，并与经胸超声心动图（TTE）中组织多普勒测量的速度进行比较。由于该方法基于改良的三尖瓣环平面收缩期位移（TAPSE）斑点追踪测量，作者还比较了 ME4C 中的斑点跟踪测量的 TAPSE 与 AP4C 中的 M 模式测量的 TAPSE。作者假设经食管超声心动图（TEE）中斑点跟踪测量的速度与 TTE 中组织多普勒测量的速度相似、相关且一致。
前瞻性诊断研究，通过 TTE（AP4C）和 TEE（ME4C）的顺序对诱导后超声心动图视图进行随机化。由 2 位超声心动图医师独立采集和分析图像。主要结局为 S'；次要结局为 E'、A'和 TAPSE。
单一大学医院。
连续接受心脏手术（主要为冠状动脉旁路移植术）的成年患者。
无。
25 例患者中的 24 例获得完整数据。对于主要结局，ME4C 中的斑点跟踪测量的 S'与 AP4C 中的组织多普勒测量的 S'相关且一致（S'=0.87S+0.60，p<0.001，r=0.78；平均偏差-0.6cm/s，95%置信区间（LoA）-3.5 至 2.4cm/s）。对于 E'也得到了类似的结果，但对于 A'则不然（E'=0.69E'+2.37，p<0.001，r=0.71；平均偏差 0.1cm/s，95%LoA -2.5 至 2.8cm/s；A'=0.15A'+11.17，p=0.629）。作者改良的斑点跟踪测量技术测量的 TAPSE 与 M 模式测量的 TAPSE 相似（分别为 18.2±5.5mm 和 17.1±3.9mm）。
TEE 中的斑点跟踪测量的三尖瓣环速度（S'、E'）似乎是 TTE 中测量速度的有前途的替代方法。这对于右心室围手术期评估可能很重要。
