Validating TEE Measurements of Right Ventricular Function

Echocardiography, Transesophageal Clinical Trial

— TEE  

Official title:

Validating Transesophageal Echocardiographic Measurements of Right Ventricular Function

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03264183
• Other study ID #: STUDY00007541
• Status: Completed
• Start date: September 18, 2017
• Est. completion date: October 10, 2018

Study information

• Verified date: June 2019
• Source: Milton S. Hershey Medical Center
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Transesophageal echocardiography (TEE) is becoming a more prevalent method of monitoring and diagnosis in the perioperative setting for critically ill patients and patients undergoing cardiac surgery. Many TEE measurements are extrapolated from transthoracic echocardiography (TTE) data and have not validated by transesophageal means. The aim of this study is to validate TEE assessment of right ventricular function by comparing them to simultaneously measured TTE measurements.

Likewise, there are currently no agreed upon values for RV free wall strain. Therefore, the investigators will attempt to define a range of normal values of RV free wall strain as compared to the other measures of RV function.

Description:

Traditionally, all echocardiographic measurements have been studied utilizing TTE. Therefore the normal values and ranges for pathology findings have been defined by transthoracic means alone. TEE offers different images planes when compared to TTE, which may make the measurements obtained differ from those obtained by TTE. In the operating room environment the vast majority of echocardiography is completed by transesophageal means for many reasons; largely access to the patient and the continuous use of TEE as a hemodynamic monitor. However, given the fact that most echocardiographic measurements have only been validated by TTE, there remains a question as to the validity or precision of TEE-derived measurements.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 126
• Est. completion date: October 10, 2018
• Est. primary completion date: October 10, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Adult patients undergoing elective cardiac surgery requiring TEE

Exclusion Criteria:

• Patient who do not wish to consent

• Patients with contraindications to TEE

• Urgent or emergent cardiac surgery

• Patients with preexisting open chest

• Patients with intrathoracic hardware (VAD, thoracostomy tube, etc)

• Non-English speaking subjects

• Cognitively impaired adults

• Pregnancy

Related Conditions & MeSH terms

• Echocardiography, Transesophageal
• Ventricular Function, Right

Intervention

Diagnostic Test:
• Transesophageal Echocardiography
TEE measures of right ventricular function
• Transthoracic Echocardiography
TTE measures of right ventricular function

Locations

Country	Name	City	State
United States	Milton S. Hershey Medical Center	Hershey	Pennsylvania

Sponsors (1)

Lead Sponsor	Collaborator
Milton S. Hershey Medical Center

Country where clinical trial is conducted

United States, 

References & Publications (28)

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Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, Reeves ST, Shanewise JS, Siu SC, Stewart W, Picard MH. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013 Sep;26(9):921-64. doi: 10.1016/j.echo.2013.07.009. — View Citation

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Kemal HS, Kayikcioglu M, Kultursay H, Vuran O, Nalbantgil S, Mogulkoc N, Can L. Right ventricular free-wall longitudinal speckle tracking strain in patients with pulmonary arterial hypertension under specific treatment. Echocardiography. 2017 Apr;34(4):530-536. doi: 10.1111/echo.13472. Epub 2017 Mar 23. — View Citation

Magunia H, Schmid E, Hilberath JN, Häberle L, Grasshoff C, Schlensak C, Rosenberger P, Nowak-Machen M. 2D Echocardiographic Evaluation of Right Ventricular Function Correlates With 3D Volumetric Models in Cardiac Surgery Patients. J Cardiothorac Vasc Anesth. 2017 Apr;31(2):595-601. doi: 10.1053/j.jvca.2016.11.020. Epub 2016 Nov 14. — View Citation

Markin NW, Chamsi-Pasha M, Luo J, Thomas WR, Brakke TR, Porter TR, Shillcutt SK. Transesophageal Speckle-Tracking Echocardiography Improves Right Ventricular Systolic Function Assessment in the Perioperative Setting. J Am Soc Echocardiogr. 2017 Feb;30(2):180-188. doi: 10.1016/j.echo.2016.10.002. Epub 2016 Dec 1. — View Citation

Mishra M, Swaminathan M, Malhotra R, Mishra A, Trehan N. Evaluation of Right Ventricular Function During CABG: Transesophageal Echocardiographic Assessment of Hepatic Venous Flow Versus Conventional Right Ventricular Performance Indices. Echocardiography. 1998 Jan;15(1):51-58. — View Citation

Morita Y, Nomoto K, Fischer GW. Modified Tricuspid Annular Plane Systolic Excursion Using Transesophageal Echocardiography for Assessment of Right Ventricular Function. J Cardiothorac Vasc Anesth. 2016 Jan;30(1):122-6. doi: 10.1053/j.jvca.2015.07.024. Epub 2015 Jul 28. — View Citation

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Portnoy SG, Rudski LG. Echocardiographic evaluation of the right ventricle: a 2014 perspective. Curr Cardiol Rep. 2015;17(4):21. doi: 10.1007/s11886-015-0578-8. Review. — View Citation

Rafferty T, Durkin M, Harris S, Elefteriades J, Hines R, Prokop E, O'Connor T. Transesophageal two-dimensional echocardiographic analysis of right ventricular systolic performance indices during coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 1993 Apr;7(2):160-6. — View Citation

Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010 Jul;23(7):685-713; quiz 786-8. doi: 10.1016/j.echo.2010.05.010. — View Citation

Shillcutt SK, Brakke TR, Thomas WR, Porter TR, Lisco SJ. The development of a perioperative echocardiography consult service: the Nebraska experience. J Cardiothorac Vasc Anesth. 2015;29(3):777-84. doi: 10.1053/j.jvca.2014.09.010. Epub 2015 Jan 6. Review. — View Citation

Shillcutt SK, Markin NW, Montzingo CR, Brakke TR. Use of rapid "rescue" perioperative echocardiography to improve outcomes after hemodynamic instability in noncardiac surgical patients. J Cardiothorac Vasc Anesth. 2012 Jun;26(3):362-70. doi: 10.1053/j.jvca.2011.09.029. Epub 2012 Jan 4. — View Citation

Sokalskis V, Peluso D, Jagodzinski A, Sinning C. Added clinical value of applying myocardial deformation imaging to assess right ventricular function. Echocardiography. 2017 Jun;34(6):919-927. doi: 10.1111/echo.13521. Epub 2017 Mar 19. Review. — View Citation

Strotmann JM, Kvitting JP, Wilkenshoff UM, Wranne B, Hatle L, Sutherland GR. Anatomic M-mode echocardiography: A new approach to assess regional myocardial function--A comparative in vivo and in vitro study of both fundamental and second harmonic imaging modes. J Am Soc Echocardiogr. 1999 May;12(5):300-7. — View Citation

Tousignant C, Bowry R, Cruz JD, Mazer CD. Induction of anesthesia does not alter tricuspid annular velocities: a tissue Doppler assessment. Can J Anaesth. 2009 Oct;56(10):757-62. doi: 10.1007/s12630-009-9157-z. Epub 2009 Jul 29. — View Citation

Tousignant C, Desmet M, Bowry R, Harrington AM, Cruz JD, Mazer CD. Speckle tracking for the intraoperative assessment of right ventricular function: a feasibility study. J Cardiothorac Vasc Anesth. 2010 Apr;24(2):275-9. doi: 10.1053/j.jvca.2009.10.022. Epub 2010 Jan 6. — View Citation

Tousignant C, Kim H, Papa F, Mazer CD. Evaluation of TAPSE as a measure of right ventricular output. Can J Anaesth. 2012 Apr;59(4):376-83. doi: 10.1007/s12630-011-9659-3. — View Citation

Williams B, Sikorski R, Anders M, Galvagno S, Rock P, Mazzeffi M. Should We Use Perioperative Transesophageal Echocardiography More in Non-Cardiac Surgery? J Cardiothorac Vasc Anesth. 2018 Jun;32(3):e71-e73. doi: 10.1053/j.jvca.2016.03.153. Epub 2016 Mar 31. — View Citation

* Note: There are 28 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Right ventricular index of myocardial performance (RIMP)	Right ventricular index of myocardial performance (RIMP) will be measured using both TTE and TEE.	Immediately following the induction of anesthesia and TEE probe placement
Primary	Tricuspid annular plane systolic excursion (TAPSE)	Tricuspid annular plane systolic excursion (TAPSE) will be measured using both TTE and TEE.	Immediately following the induction of anesthesia and TEE probe placement
Primary	Right ventricular fractional area change (FAC)	Right ventricular fractional area change (FAC) will be measured using both TTE and TEE.	Immediately following the induction of anesthesia and TEE probe placement
Primary	RV annular systolic velocity (S`)	RV annular systolic velocity (S`) will be measured using both TTE and TEE.	Immediately following the induction of anesthesia and TEE probe placement
Primary	RV free wall longitudinal strain	RV free wall longitudinal strain will be measured using both TTE and TEE.	Immediately following the induction of anesthesia and TEE probe placement
Secondary	Ease of obtaining appropriate TEE measures of right ventricular function	Ease of acquisition will be assessed by the echocardiographers	Within 15 minutes following anesthesia induction
Secondary	Define values for normal right ventricular free wall strain	The data collected will be used to define normal values for right ventricular free wall strain	Through study completion, an estimate of 1 year