Comparing Cardiac Chamber Measurements: TTE vs. TEE Under Anesthesia

Official title

Reassessing Normative Cardiac Chamber Measurements: A Comparative Study of TTE and TEE Under General Anesthesia.

Overview

This study aims to compare two common ultrasound techniques used during heart surgery: transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). TTE is performed by placing an ultrasound probe on the chest, while TEE involves inserting a probe into the esophagus, which provides closer and clearer images of the heart. Both methods are part of routine care for patients undergoing heart surgery. The goal of this study is to assess how well the measurements from TTE and TEE agree in evaluating heart chamber dimensions during surgery and to investigate how factors such as anesthesia, breathing techniques affect these measurements. This research involves 114 adult patients scheduled for heart surgery at Sunnybrook Health Sciences Centre. Participants will have TTE performed before and after surgery, and TEE will be conducted during surgery. All procedures are part of the usual standard of care. By comparing these imaging techniques, the study seeks to provide more accurate and up-to-date guidelines for cardiac measurements, ensuring better care for patients during heart surgery.

Detailed description

This observational study compares transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in measuring cardiac chamber dimensions in adult patients undergoing cardiac surgery. While both techniques are integral to clinical care, TEE is typically used intraoperatively for its superior image quality, and TTE is performed preoperatively as a non-invasive diagnostic tool. However, differences in measurement values between TTE and TEE, particularly under the physiological changes induced by general anesthesia and positive end-expiratory pressure (PEEP), remain poorly understood. This study seeks to address this gap and update normative cardiac measurement values.

Study Design: A prospective observational study enrolling patients scheduled for coronary revascularization surgery at Sunnybrook Health Sciences Centre (n=114). All imaging procedures are part of routine clinical care.

Primary Objective: To evaluate the agreement between preoperative TTE and intraoperative TEE measurements of cardiac chamber dimensions.

Secondary Objectives:

* To explore how physiological changes from general anesthesia and PEEP impact the correlation between TTE and TEE measurements. * To analyze how pre-existing cardiac conditions (e.g., hypertension, diabetes, atrial fibrillation) affect the agreement between these modalities.

Interventions

• Diagnostic test Transthoracic Echocardiography (TTE) and Transesophageal Echocardiography (TEE)
  Transthoracic echocardiography (TTE) is a non-invasive imaging technique performed by placing an ultrasound transducer on the chest to obtain detailed heart images. TTE is conducted preoperatively on awake patients within two weeks prior to cardiac surgery, following ASE chamber quantification guidelines. Transesophageal echocardiography (TEE) is an invasive imaging technique where an ultrasound transducer is placed in the esophagus, providing closer and clearer images of the heart. TEE is perf

Primary outcome measures

• Correlation between preoperative TTE and intraoperative TEE measurements [Time frame: Within 2 weeks prior to surgery and during surgery]

Secondary outcome measures (3)

• Impact of general anesthesia on correlation between TTE and TEE. [Time frame: Within 2 weeks prior to surgery and during surgery]
• Impact of PEEP on correlation between TTE and TEE [Time frame: Within 2 weeks prior to surgery and during surgery]
• Impact of cardiac conditions on correlation between TTE and TEE. [Time frame: Within 2 weeks prior to surgery and during surgery]

Eligibility criteria

Inclusion criteria

• Age ≥ 18, able to provide informed consent.
• Patients scheduled for coronary revascularization cardiac surgery under general anesthesia.
• With normal left ventricular (LV) systolic function, defined by an ejection fraction of 50% or more, and normal right ventricular (RV) systolic function.
• Requiring intraoperative echocardiographic assessment.

Exclusion criteria

• Patients with contraindications to either transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE).
• History of poor-quality echocardiography data that preclude accurate assessment.
• Undergoing emergency cardiac surgery.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Cohort

Study locations

Canada · 1 center

• Sunnybrook Health Sciences Centre — Toronto

Publications

• Kabirdas D, Scridon C, Brenes JC, Hernandez AV, Novaro GM, Asher CR. Accuracy of transthoracic echocardiography for the measurement of the ascending aorta: comparison with transesophageal echocardiography. Clin Cardiol. 2010 Aug;33(8):502-7. doi: 10.1002/clc.20807. PMID 20734448
• Singh H, Jain AC, Bhumbla DK, Failinger C. Comparison of left atrial dimensions by transesophageal and transthoracic echocardiography. Echocardiography. 2005 Nov;22(10):789-96. doi: 10.1111/j.1540-8175.2005.00128.x. PMID 16343160
• Shiran A, Adawi S, Ganaeem M, Asmer E. Accuracy and reproducibility of left ventricular outflow tract diameter measurement using transthoracic when compared with transesophageal echocardiography in systole and diastole. Eur J Echocardiogr. 2009 Mar;10(2):319-24. doi: 10.1093/ejechocard/jen254. Epub 2008 Oct 2. PMID 18835821
• Block M, Hourigan L, Bellows WH, Reeves J 3rd, Romson JL, Tran M, Pastor D, Schiller NB, Leung JM. Comparison of left atrial dimensions by transesophageal and transthoracic echocardiography. J Am Soc Echocardiogr. 2002 Feb;15(2):143-9. doi: 10.1067/mje.2002.121399. PMID 11836489
• Assanangkornchai N, Villeneuve V, McDonald S, Magder S, Shum Tim D, Buithieu J, Hatzakorzian R. Interchangeability of transthoracic and transesophageal echocardiographic right heart measurements in the perioperative setting and correlation with hemodynamic parameters. Int J Cardiovasc Imaging. 2023 Mar;39(3):555-563. doi: 10.1007/s10554-022-02754-1. Epub 2022 Nov 18. PMID 36399180
• Skarvan K, Lambert A, Filipovic M, Seeberger M. Reference values for left ventricular function in subjects under general anaesthesia and controlled ventilation assessed by two-dimensional transoesophageal echocardiography. Eur J Anaesthesiol. 2001 Nov;18(11):713-22. doi: 10.1046/j.1365-2346.2001.00915.x. PMID 11580777
• Cohen GI, White M, Sochowski RA, Klein AL, Bridge PD, Stewart WJ, Chan KL. Reference values for normal adult transesophageal echocardiographic measurements. J Am Soc Echocardiogr. 1995 May-Jun;8(3):221-30. doi: 10.1016/s0894-7317(05)80031-8. PMID 7640014
• Teran F, Prats MI, Nelson BP, Kessler R, Blaivas M, Peberdy MA, Shillcutt SK, Arntfield RT, Bahner D. Focused Transesophageal Echocardiography During Cardiac Arrest Resuscitation: JACC Review Topic of the Week. J Am Coll Cardiol. 2020 Aug 11;76(6):745-754. doi: 10.1016/j.jacc.2020.05.074. PMID 32762909

Identifiers

NCT: NCT06715371 · 6347

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗