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Assessment of Left Ventricular Size and Function during Cardiac Surgery. An Intraoperative Evaluation of Six Two‐Dimensional Echocardiographic Methods with Real Time Three‐Dimensional Echocardiography as a Reference
Author(s) -
Grossgasteiger Manuel,
Hien Maximilian D.,
Graser Bastian,
Rauch Helmut,
Gondan Matthias,
Motsch Johann,
Rosendal Christian
Publication year - 2013
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12116
Subject(s) - biplane , ejection fraction , medicine , limits of agreement , ventricular function , speckle tracking echocardiography , nuclear medicine , diastolic function , cardiology , cardiac function curve , diastole , blood pressure , heart failure , aerospace engineering , engineering
Transesophageal echocardiography is recommended to monitor left ventricular ( LV ) size and function in various operations. Generally, two‐dimensional (2 D ) methods are applied intraoperatively. The aim of this study was to compare the accuracy and feasibility of 6 commonly used 2 D methods to assess LV function during surgery. LV function in 120 consecutive patients was evaluated. Real time three‐dimensional transesophageal echocardiograpy (3DTEE) served as reference. End‐diastolic and end‐systolic volumes and ejection fraction ( EF ) were analyzed with Simpson's method of discs (monoplane [ MP ] and biplane [ BP ]), eyeball method, T eichholz' method, and speckle tracking ( ST ) methods. Furthermore, fractional area change ( FAC ) and peak systolic pressure rise ( dP /dt) were determined. Each 2 D method was evaluated regarding correlation and agreement with 3 DE , intra‐ and interobserver variability and the time required for evaluation. Simpson BP showed the strongest correlation and best agreement with 3 DE for EF (limits of agreement 3.7 ± 11.6%) and volumes. Simpson MP showed similar agreement with 3 DE compared to ST (2.8 ± 14.5% vs. 2.0 ± 15.3% and 3.8 ± 14.4% vs. 1.9 ± 15.6%, respectively). Both the eyeball method and T eichholz' method showed wide limits of agreement (−1.5 ± 18.2% and 5.2 ± 22.1%, respectively). DP/dt did not correlate with 3 DE . FAC and ST FAC showed similar agreement. Application of 3 DE (429 ± 108 seconds) took the longest time, and the eyeball method took the shortest time (8 ± 5 seconds) for analysis. Simpson BP is the most accurate intraoperative 2 D method to evaluate LV function, followed by long‐axis MP evaluations. Short‐axis views were less accurate but may be suited for monitoring. We do not recommend using dP/dt.