A Novel Speckle-Tracking Based Method for Quantifying Tricuspid Annular Velocities in TEE

Abstract

A novel speckle-tracking-based option for measuring tricuspid annular velocities in the midesophageal 4-chamber view (ME4C) was compared with velocities measured by tissue Doppler in the apical-4 chamber view (AP4C). Because this method was based on a modified speckle-tracking-based measurement of tricuspid annular plane systolic excursion (TAPSE), the authors also compared TAPSE by speckle tracking in the ME4C with TAPSE by M-mode in the AP4C. The authors hypothesized that velocities measured by speckle tracking in transesophageal echocardiography (TEE) would be similar, correlate, and agree with those measured by tissue Doppler in transthoracic echocardiography (TTE). Prospective diagnostic study with randomization of the order of post-induction echocardiography views by TTE (AP4C) and TEE (ME4C). Images were both acquired and analyzed by 2 echocardiographers independently. The primary outcome was S'; secondary outcomes were E', A', and TAPSE. Single university hospital. Consecutive adult patients undergoing cardiac surgery (mainly coronary artery bypass grafting). None. Complete data was available in 24 of 25 patients. For the primary outcome, S' measured by speckle tracking in the ME4C correlated and agreed with S' measured by tissue Doppler in the AP4C (S'STE = 0.87STDI + 0.60, p < 0.001, r = 0.78; mean bias -0.6 cm/s, 95% limits of agreement (LoA) -3.5 to 2.4 cm/s). Similarly results were found for E', but not A' (E'STE = 0.69E'TDI + 2.37, p < 0.001, r = 0.71; mean bias 0.1 cm/s, 95%LoA -2.5 to 2.8cm/s; A'STE = 0.15A'TDI + 11.17, p = 0.629). TAPSE measurements by the authors' modified speckle-tracking-based technique were similar to TAPSE by M-mode (18.2 ± 5.5 mm and 17.1 ± 3.9 mm, respectively). Tricuspid annular velocities (S'STE, E'STE) determined by speckle tracking in TEE seem to be promising surrogates for velocities measured in TTE. This may be important for perioperative assessment of the right ventricle.