title: Transesophageal Speckle-Tracking Echocardiography Improves Right Ventricular Systolic Function Assessment in the Perioperative Setting.
abstract: Perioperative evaluation of right ventricular (RV) systolic function is important to follow intraoperative changes, but it is often not possible to assess with transthoracic echocardiographic (TTE) imaging, because of surgical field constraints. Echocardiographic RV quantification is most commonly performed using tricuspid annular plane systolic excursion (TAPSE), but it is not clear whether this method works with transesophageal echocardiographic (TEE) imaging. This study was performed to evaluate the relationship between TTE and TEE TAPSE distances measured with M-mode imaging and in comparison with speckle-tracking TTE and TEE measurements.
  
  
  
  Prospective observational TTE and TEE imaging was performed during elective cardiac surgical procedures in 100 subjects. Speckle-tracking echocardiographic TAPSE distances were determined and compared with the TTE M-mode TAPSE standard. Both an experienced and an inexperienced user of the speckle-tracking echocardiographic software evaluated the images, to enable interobserver assessment in 84 subjects.
  
  
  
  The comparison between TTE M-mode TAPSE and TEE M-mode TAPSE demonstrated significant variability, with a Spearman correlation of 0.5 and a mean variance in measurement of 6.5 mm. There was equivalence within data pairs and correlations between TTE M-mode TAPSE and both speckle-tracking TTE and speckle-tracking TEE TAPSE, with Spearman correlations of 0.65 and 0.65, respectively. The average variance in measurement was 0.6 mm for speckle-tracking TTE TAPSE and 1.5 mm for speckle-tracking TEE TAPSE.
  
  
  
  Using TTE M-mode TAPSE as a control, TEE M-mode TAPSE results are not accurate and should not be used clinically to evaluate RV systolic function. The relationship between speckle-tracking echocardiographic TAPSE and TTE M-mode TAPSE suggests that in the perioperative setting, speckle-tracking TEE TAPSE might be used to quantitatively evaluate RV systolic function in the absence of TTE imaging.
authors.affiliation: Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: nmarkin@unmc.edu.
authors.forename: Nicholas W
authors.initials: NW
authors.lastname: Markin
authors.affiliation: Section of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Chamsi-Pasha
authors.affiliation: Division of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Jiangtao
authors.initials: J
authors.lastname: Luo
authors.affiliation: Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Walker R
authors.initials: WR
authors.lastname: Thomas
authors.affiliation: Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Tara R
authors.initials: TR
authors.lastname: Brakke
authors.affiliation: Section of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Porter
authors.affiliation: Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Sasha K
authors.initials: SK
authors.lastname: Shillcutt
mesh_terms: D000368:Aged; D017548:Echocardiography, Transesophageal / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging*
keywords: Right ventricular function quantification; Speckle-tracking echocardiography; Transesophageal echocardiography; Transthoracic echocardiography