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Relationship between tricuspid annular excursion and velocity in cardiac surgical patients.
J Cardiothorac Vasc Anesth. 2014 Oct; 28(5):1198-202.JC

Abstract

OBJECTIVES

The primary objective of this study was to establish the relationship among tricuspid annular velocity (S'), tricuspid annular plane systolic excursion (TAPSE), and stroke volume (SV) in a cardiac surgical population with and without right ventricular (RV) dysfunction. The secondary objective was to assess the effect of ephedrine on these relationships in a population without RV dysfunction.

DESIGN

Prospective, nonrandomized, unblinded study.

SETTING

Single tertiary-level, university-affiliated hospital.

PARTICIPANTS

Twenty-seven patients undergoing elective coronary artery bypass grafting with no evidence of RV dysfunction (Group 1). Sixteen ventilated postcardiac surgical patients with suspected RV dysfunction (Group 2).

INTERVENTIONS

Ten mg of intravenous ephedrine to Group 1 only.

MEASUREMENTS AND MAIN RESULTS

Using transthoracic echocardiography, S' and TAPSE were measured using color tissue Doppler applied at the RV base in a 4-chamber view. SV was calculated using thermodilution. Six patients in Group 1 and 6 patients in Group 2 were excluded because of poor imaging or ineligibility. Modest correlation was found between TAPSE and SV in Group 1 (R = 0.50, p<0.001). There was no correlation between TAPSE and SV in Group 2. There was no correlation between S' and SV in both groups. In Group 1, the relationship between TAPSE and S' was curvilinear (R = 0.74 pre-ephedrine, p<0.001; R = 0.64, p = 0.009 post-ephedrine). There was no relationship between TAPSE and S' in Group 2. Ephedrine increased S' and TAPSE. The TAPSE-S' relationship was not significantly altered.

CONCLUSIONS

In the presence of RV dysfunction, TAPSE did not correlate with cardiac output. In the absence of RV dysfunction, the relationship between TAPSE and S' described a curvilinear relationship.

Authors+Show Affiliations

Department of Anaesthesia, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.Department of Anaesthesia, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.Department of Anaesthesia, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: tousignantc@smh.ca.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24447502

Citation

Hu, Raymond, et al. "Relationship Between Tricuspid Annular Excursion and Velocity in Cardiac Surgical Patients." Journal of Cardiothoracic and Vascular Anesthesia, vol. 28, no. 5, 2014, pp. 1198-202.
Hu R, Mazer CD, Tousignant C. Relationship between tricuspid annular excursion and velocity in cardiac surgical patients. J Cardiothorac Vasc Anesth. 2014;28(5):1198-202.
Hu, R., Mazer, C. D., & Tousignant, C. (2014). Relationship between tricuspid annular excursion and velocity in cardiac surgical patients. Journal of Cardiothoracic and Vascular Anesthesia, 28(5), 1198-202. https://doi.org/10.1053/j.jvca.2013.10.005
Hu R, Mazer CD, Tousignant C. Relationship Between Tricuspid Annular Excursion and Velocity in Cardiac Surgical Patients. J Cardiothorac Vasc Anesth. 2014;28(5):1198-202. PubMed PMID: 24447502.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship between tricuspid annular excursion and velocity in cardiac surgical patients. AU - Hu,Raymond, AU - Mazer,C David, AU - Tousignant,Claude, Y1 - 2014/01/18/ PY - 2013/08/14/received PY - 2014/1/23/entrez PY - 2014/1/23/pubmed PY - 2015/12/15/medline KW - TAPSE KW - color-tissue Doppler KW - right ventricular function KW - tricuspid annular velocity SP - 1198 EP - 202 JF - Journal of cardiothoracic and vascular anesthesia JO - J Cardiothorac Vasc Anesth VL - 28 IS - 5 N2 - OBJECTIVES: The primary objective of this study was to establish the relationship among tricuspid annular velocity (S'), tricuspid annular plane systolic excursion (TAPSE), and stroke volume (SV) in a cardiac surgical population with and without right ventricular (RV) dysfunction. The secondary objective was to assess the effect of ephedrine on these relationships in a population without RV dysfunction. DESIGN: Prospective, nonrandomized, unblinded study. SETTING: Single tertiary-level, university-affiliated hospital. PARTICIPANTS: Twenty-seven patients undergoing elective coronary artery bypass grafting with no evidence of RV dysfunction (Group 1). Sixteen ventilated postcardiac surgical patients with suspected RV dysfunction (Group 2). INTERVENTIONS: Ten mg of intravenous ephedrine to Group 1 only. MEASUREMENTS AND MAIN RESULTS: Using transthoracic echocardiography, S' and TAPSE were measured using color tissue Doppler applied at the RV base in a 4-chamber view. SV was calculated using thermodilution. Six patients in Group 1 and 6 patients in Group 2 were excluded because of poor imaging or ineligibility. Modest correlation was found between TAPSE and SV in Group 1 (R = 0.50, p<0.001). There was no correlation between TAPSE and SV in Group 2. There was no correlation between S' and SV in both groups. In Group 1, the relationship between TAPSE and S' was curvilinear (R = 0.74 pre-ephedrine, p<0.001; R = 0.64, p = 0.009 post-ephedrine). There was no relationship between TAPSE and S' in Group 2. Ephedrine increased S' and TAPSE. The TAPSE-S' relationship was not significantly altered. CONCLUSIONS: In the presence of RV dysfunction, TAPSE did not correlate with cardiac output. In the absence of RV dysfunction, the relationship between TAPSE and S' described a curvilinear relationship. SN - 1532-8422 UR - https://www.unboundmedicine.com/medline/citation/24447502/Relationship_between_tricuspid_annular_excursion_and_velocity_in_cardiac_surgical_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-0770(13)00529-6 DB - PRIME DP - Unbound Medicine ER -