Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium; Department of Anesthesiology, University Hospital Basel, Basel, Switzerland.
Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium.
J Cardiothorac Vasc Anesth. 2020 Aug;34(8):2152-2161. doi: 10.1053/j.jvca.2020.03.009. Epub 2020 Mar 13.
First, to compare tricuspid annular displacement and velocity in transthoracic and transesophageal echocardiography (TTE, TEE) using conventional angle-dependent technologies. Second, to evaluate both alternative TEE views as well as an alternative technology (speckle tracking) for overcoming proposed differences in TTE and TEE.
Prospective, comparative, cross-over study with a randomized order of image acquisition.
University hospital.
Adults undergoing cardiac surgery.
Postinduction standardized image acquisition and analysis in TTE and TEE by 2 echocardiographers.
The authors measured tricuspid annular plane systolic excursion (TAPSE) by M-mode and velocity by tissue Doppler (S') in the apical 4-chamber TTE view and midesophageal 4-chamber TEE view (AP4C, ME4C). They then examined (1) the same measurements in alternative TEE views with proposed better ultrasound angulation; and (2) speckle tracking-based endpoints (TAPSE by speckle tracking, strain, and strain rate). Data were available in 24 of 25 patients. Conventional TAPSE by M-mode and velocity by tissue Doppler (TDI) were underestimated in the ME4C compared with the AP4C reference (mean ± standard deviation: TAPSE: 13.1 ± 3.8 mm v 17.3 ± 4.0 mm; S': 6.7 ± 2.1 cm/s v 9.1 ± 2.2 cm/s; both p < 0.001). Neither a modified deep transgastric view (TAPSE 14.5 ± 4.7 mm, p = 0.017; S' 6.8 ± 1.8 cm/s, p < 0.001) nor a transgastric right ventricular inflow view (TAPSE 12.3 ± 4.0 mm, p = 0.001; S' 6.0 ± 1.3 cm/s, p < 0.001) was similar to the AP4C. Speckle tracking TAPSE was unbiased but with high variability (mean bias = -0.3 mm, 95% limits of agreement = -9.1 to 8.4); strain and strain rate were higher in TEE than for TTE (-17.7 ± 3.6 v -12.6 ± 2.1, p < 0.001; -1.0 ± 0.2/s v -0.7 ± 0.1/s, p < 0.001).
Right ventricular displacement, velocity, and myocardial deformation measured by TEE versus TTE are different. Neither alternative transesophageal echocardiography views nor speckle tracking-based deformation is promising; TAPSE by speckle tracking is unbiased but imprecise.
首先，比较经胸超声心动图（TTE）和经食管超声心动图（TEE）中使用传统角度依赖技术的三尖瓣环位移和速度。其次，评估替代 TEE 视图以及替代技术（斑点跟踪），以克服 TTE 和 TEE 中提出的差异。
前瞻性、比较、交叉研究，具有随机采集图像的顺序。
大学医院。
接受心脏手术的成年人。
由 2 名超声心动图医师在 TTE 和 TEE 中进行诱导后标准化图像采集和分析。
作者通过 M 模式测量三尖瓣环收缩期位移（TAPSE）和组织多普勒（S'）在经胸心尖 4 腔 TTE 视图和经食管中 4 腔 TEE 视图（AP4C、ME4C）中的速度。然后检查（1）在具有更好超声角度的替代 TEE 视图中进行相同的测量；（2）基于斑点跟踪的终点（斑点跟踪的 TAPSE、应变和应变速率）。25 名患者中有 24 名患者的数据可用。与 AP4C 参考相比，M 模式的常规 TAPSE 和组织多普勒（TDI）的速度在 ME4C 中被低估（平均值±标准偏差：TAPSE：13.1±3.8mm v 17.3±4.0mm；S'：6.7±2.1cm/s v 9.1±2.2cm/s；均 p<0.001）。改良的经胃深视图（TAPSE 14.5±4.7mm，p=0.017；S'6.8±1.8cm/s，p<0.001）和经胃右心室流入道视图（TAPSE 12.3±4.0mm，p=0.001；S'6.0±1.3cm/s，p<0.001）均与 AP4C 不相似。斑点跟踪 TAPSE 无偏但具有高变异性（平均偏差=-0.3mm，95%置信区间=-9.1 至 8.4）；TEE 中的应变和应变速率高于 TTE（-17.7±3.6 v -12.6±2.1，p<0.001；-1.0±0.2/s v -0.7±0.1/s，p<0.001）。
TEE 与 TTE 相比，右心室位移、速度和心肌变形不同。替代的经食管超声心动图视图或基于斑点跟踪的变形都没有前途；斑点跟踪的 TAPSE 无偏但不精确。
