Intraoperative detection of segmental wall motion abnormalities with transesophageal echocardiography.
OBJECTIVE
To compare two methods of analysis of regional wall-motion (RWM) using transesophageal echocardiography (TEE).


METHODS
Thirty patients undergoing coronary artery bypass surgery were studied. The transgastric short axis view at the mid-papillary level was recorded before and after cardiopulmonary bypass. All images were reviewed by an anesthesiologist trained in TEE and an echocardiographer. Regional wall motion was graded: 1 normal, 2 hypokinetic, 3 akinetic, and 4 dyskinetic. The left ventricle was evaluated according to the guidelines of the American Society of Echocardiography using 6-segment, and 4-segment models. Agreement between observers (interobservers), and for one observer at two different moments (intraobservers), for grading each segment was defined as RWM abnormality scores within 1 grade. A wall-motion score index (WMSI), which is the sum of individual scores divided by the number of segments visualized, was calculated. A Bland Altman analysis was used to assess interobserver variability.


RESULTS
Agreement between observers occurred in 96% and 94% of the examined segments, using 4- and 6-segment models respectively. Intraobserver agreement was 99% and 97% for the 4- and 6-segment models. The mean differences (bias) of the interobserver variability in grading the segments were 0.04 +/- 0.79 and 0 +/- 0.72 using a 4- or 6-segment model. The mean difference of the interobserver variability in WMSI were -0.05 +/- 0.42 and 0.05 +/- 0.37 using a 4- or a 6-segment model.


CONCLUSIONS
Both methods, using either a 4- or a 6-segment model, result in a high intraobserver and interobserver agreement, and a low interobserver variability.
Couture
P
P
Department of Anesthesia, Montreal Heart Institute, Quebec, Canada. pcouture@sympatico.ca
Denault
A Y
AY
Carignan
S
S
Boudreault
D
D
Babin
D
D
Ruel
M
M
D001026:Coronary Artery Bypass; D017548:Echocardiography, Transesophageal; D006801:Humans; D016343:Monitoring, Intraoperative; D015588:Observer Variation; D010210:Papillary Muscles / Q000502:physiology; D016276:Ventricular Function; D016277:Ventricular Function, Left / Q000502:physiology*