Speckle Tracking for the Intraoperative Assessment of Right Ventricular Function: A Feasibility Study

Objectives

Speckle tracking is an ultrasound method that assesses B-mode features to measure tissue displacement and derive deformation parameters. The objective of this study was to assess the feasibility of using speckle tracking in the measurement of right ventricular (RV) longitudinal strain during cardiac surgery using transesophageal echocardiography (TEE).

Design

This was a prospective, observational cohort study.

Setting

A single university hospital setting.

Participants

Twenty-one patients without valvular disease referred for coronary artery bypass graft surgery were studied.

Interventions

None.

Measurements and Main Results

After the induction of anesthesia and mechanical ventilation, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were used to obtain tricuspid annular plane systolic excursion (TAPSE), RV fractional area of change (FAC), and 2-dimensional strain analysis (speckle tracking) on 3 consecutive heart beats. There was a larger percentage of measurable segments achieved when using TEE. All segments could be analyzed per cardiac cycle in 73% of loops when using TEE and 38% when using TTE. The global strain value was similar using both methods (TEE: −20.4%, TTE: −20.1%). The TAPSE could be measured in only 52% of the segments using TTE and 100% using TEE. The FAC could be measured in 90.5% of the loops using TEE and in only 33.3% of the loops using TTE.

Conclusions

Perioperative measurements of RV strain using TEE in ventilated patients is feasible. The success rate was higher using TEE in ventilated patients under anesthesia. Differences between the 2 methods were likely the result of differences in 2-dimensional image quality.

Key Words: right ventricular function, transesophageal echocardiography, myocardial strain, transthoracic echocardiography, speckle tracking, intraoperative