Assessment of Image Quality of Repeated Limited Transthoracic Echocardiography After Cardiac Surgery.
OBJECTIVE
The use of limited transthoracic echocardiography (TTE) has been restricted in patients after cardiac surgery due to reported poor image quality. The authors hypothesized that the hemodynamic state could be evaluated in a high proportion of patients at repeated intervals after cardiac surgery.


METHODS
Prospective observational study.


METHODS
Tertiary university hospital.


METHODS
The study comprised 51 patients aged 18 years or older presenting for cardiac surgery.


METHODS
Patients underwent TTE before surgery and at 3 time points after cardiac surgery. Images were assessed offline using an image quality scoring system by 2 expert observers. Hemodynamic state was assessed using the iHeartScan protocol, and the primary endpoint was the proportion of limited TTE studies in which the hemodynamic state was interpretable at each of the 3 postoperative time points.


RESULTS
Hemodynamic state interpretability varied over time and was highest before surgery (90%) and lowest on the first postoperative day (49%) (p<0.01). This variation in interpretability over time was reflected in all 3 transthoracic windows, ranging from 43% to 80% before surgery and from 2% to 35% on the first postoperative day (p<0.01). Image quality scores were highest with the apical window, ranging from 53% to 77% across time points, and lowest with the subcostal window, ranging from 4% to 70% across time points (p< 0.01).


CONCLUSIONS
Hemodynamic state can be determined with TTE in a high proportion of cardiac surgery patients after extubation and removal of surgical drains.
Department of Anesthesia and Pain Management, Royal Melbourne Hospital and Monash Medical Centre, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia.
David J
DJ
Canty
Department of Anesthesia and Pain Management, Royal Melbourne Hospital and Monash Medical Centre, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia. Electronic address: johan.heiberg@clin.au.dk.
Johan
J
Heiberg
Department of Anesthesia and Pain Management, Royal Melbourne Hospital and Monash Medical Centre, Melbourne, Australia.
Jen A
JA
Tan
Department of Critical Care Medicine, Western Hospital, Footscray, Melbourne, Australia.
Yang
Y
Yang
Department of Surgery, University of Melbourne, Melbourne, Australia; Department of Surgery, Royal Melbourne Hospital, Melbourne, Australia.
Alistair G
AG
Royse
Department of Anesthesia and Pain Management, Royal Melbourne Hospital and Monash Medical Centre, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia.
Colin F
CF
Royse
King Fahad Cardiac Centre & College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Abdulelah
A
Mobeirek
King Fahad Cardiac Centre & College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Fayez El
FE
Shaer
King Fahad Cardiac Centre & College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Turki
T
Albacker
King Fahad Cardiac Centre & College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Rakan I
RI
Nazer
King Fahad Cardiac Centre & College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Muhammed
M
Fouda
King Fahad Cardiac Centre & College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Bakir M
BM
Bakir
King Fahad Cardiac Centre & College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Ahmed A
AA
Alsaddique
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000592:standards*; D004452:Echocardiography / Q000379:methods / Q000592:standards*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007089:Image Enhancement / Q000379:methods / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods / Q000592:standards*; D011446:Prospective Studies
feasibility; image quality; monitoring; transthoracic echocardiography; ultrasonography