Interchangeability of right ventricular longitudinal shortening fraction assessed by transthoracic and transoesophageal echocardiography in the perioperative setting: A prospective study

Abstract

Background: Conventional transthoracic (TTE) and transoesophageal echocardiography (TEE) parameters assessing right ventricle (RV) systolic function are daily used assuming their clinical interchangeability. RV longitudinal shortening fraction (RV-LSF) is a two-dimensional speckle tracking parameter used to assess RV systolic function. RV-LSF is based on tricuspid annular displacement analysis and could be measured with TTE or TEE.

Objective: The aim of the study was to determine if RV-LSF_TTE and RV-LSF_TEE measurements were interchangeable in the perioperative setting.

Methods: Prospective perioperative TTE and TEE echocardiography were performed under general anesthesia during scheduled cardiac surgery in 90 patients. RV-LSF was measured by semi-automatic software. Comparisons were performed using Pearson correlation and Bland-Altman plots. RV-LSF clinical agreement was determined as a range of -5 to 5%.

Results: Of the 114 patients who met the inclusion criteria, 90 were included. The mean preoperative RV-LSF_TTE was 20.4 ± 4.3 and 21.1 ± 4.1% for RV-LSF_TEE. The agreement between RV-LSF measurements was excellent, with a bias at -0.61 and limits of agreement of -4.18 to 2.97 %. All measurements fell within the determined clinical agreement interval in the Bland-Altman plot. Linear regression analysis showed a high correlation between RV-LSF_TTE and RV-LSF_TEE measurement (r = 0.9; confidence interval [CI] 95%: [0.87-0.94], p < 0.001).

Conclusion: RV-LSF_TTE and RV-LSF_TEE measurements are interchangeable, allowing RV-LSF to be a helpful parameter for assessing perioperative changes in RV systolic function.

Nct: NCT05404737. https://www.clinicaltrials.gov/ct2/show/NCT05404737.

Keywords: interchangeability; right ventricle; right ventricular shortening fraction; speckle tracking; tricuspid.