Relationship between tricuspid annular excursion and velocity in cardiac surgical patients.
OBJECTIVE
The primary objective of this study was to establish the relationship among tricuspid annular velocity (S'), tricuspid annular plane systolic excursion (TAPSE), and stroke volume (SV) in a cardiac surgical population with and without right ventricular (RV) dysfunction. The secondary objective was to assess the effect of ephedrine on these relationships in a population without RV dysfunction.


METHODS
Prospective, nonrandomized, unblinded study.


METHODS
Single tertiary-level, university-affiliated hospital.


METHODS
Twenty-seven patients undergoing elective coronary artery bypass grafting with no evidence of RV dysfunction (Group 1). Sixteen ventilated postcardiac surgical patients with suspected RV dysfunction (Group 2).


METHODS
Ten mg of intravenous ephedrine to Group 1 only.


RESULTS
Using transthoracic echocardiography, S' and TAPSE were measured using color tissue Doppler applied at the RV base in a 4-chamber view. SV was calculated using thermodilution. Six patients in Group 1 and 6 patients in Group 2 were excluded because of poor imaging or ineligibility. Modest correlation was found between TAPSE and SV in Group 1 (R = 0.50, p<0.001). There was no correlation between TAPSE and SV in Group 2. There was no correlation between S' and SV in both groups. In Group 1, the relationship between TAPSE and S' was curvilinear (R = 0.74 pre-ephedrine, p<0.001; R = 0.64, p = 0.009 post-ephedrine). There was no relationship between TAPSE and S' in Group 2. Ephedrine increased S' and TAPSE. The TAPSE-S' relationship was not significantly altered.


CONCLUSIONS
In the presence of RV dysfunction, TAPSE did not correlate with cardiac output. In the absence of RV dysfunction, the relationship between TAPSE and S' described a curvilinear relationship.
Department of Anaesthesia, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Raymond
R
Hu
Department of Anaesthesia, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
C David
CD
Mazer
Department of Anaesthesia, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: tousignantc@smh.ca.
Claude
C
Tousignant
D000368:Aged; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D004452:Echocardiography / Q000706:statistics & numerical data*; D018618:Echocardiography, Doppler, Color / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*; D014261:Tricuspid Valve / Q000502:physiology*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*
TAPSE; color-tissue Doppler; right ventricular function; tricuspid annular velocity