Comparison of the Quality of Echocardiography Imaging Between the Left Lateral Decubitus and Supine Positions

Ottenhoff, Jakob; Hewitt, Matthew; Makonnen, Nardos; Kongkatong, Matthew; Thom, Christopher

doi:10.7759/cureus.31835

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…According to current guidelines, transthoracic apical four and two chambre views should ideally be acquired in the left lateral position to maximise image quality and avoid foreshortening [ 37 ]. However, for several reasons, this recommendation is only achievable in cardiology echocardiography clinics but rarely in perioperative and ICU settings and, strictly speaking, there is only little formal evidence of improved TTE imaging quality in the left lateral compared with the supine position [ 38 ]. The anaesthetised patients in our study, therefore, remained supine during the examinations to reflect such perioperative conditions.…”

Section: Discussionmentioning

confidence: 99%

Quantification of left ventricular ejection fraction and cardiac output using a novel semi-automated echocardiographic method: a prospective observational study in coronary artery bypass patients

et al. 2023

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Background Echocardiographic quantification of ejection fraction (EF) by manual endocardial tracing requires training, is time-consuming and potentially user-dependent, whereas determination of cardiac output by pulmonary artery catheterization (PAC) is invasive and carries a risk of complications. Recently, a novel software for semi-automated EF and CO assessment (AutoEF) using transthoracic echocardiography (TTE) has been introduced. We hypothesized that AutoEF would provide EF values different from those obtained by the modified Simpson’s method in transoesophageal echocardiography (TOE) and that AutoEF CO measurements would not agree with those obtained via VTILVOT in TOE and by thermodilution using PAC. Methods In 167 patients undergoing coronary artery bypass graft surgery (CABG), TTE cine loops of apical 4- and 2-chamber views were recorded after anaesthesia induction under steady-state conditions. Subsequently, TOE was performed following a standardized protocol, and CO was determined by thermodilution. EF and CO were assessed by TTE AutoEF as well as TOE, using the modified Simpson’s method, and Doppler measurements via velocity time integral in the LV outflow tract (VTILVOT). We determined Pearson’s correlation coefficients r and carried out Bland–Altman analyses. The primary endpoints were differences in EF and CO. The secondary endpoints were differences in left ventricular volumes at end diastole (LVEDV) and end systole (LVESV). Results AutoEF and the modified Simpson’s method in TOE showed moderate EF correlation (r = 0.38, p < 0.01) with a bias of -12.6% (95% limits of agreement (95%LOA): -36.6 – 11.3%). AutoEF CO correlated poorly both with VTILVOT in TOE (r = 0.19, p < 0.01) and thermodilution (r = 0.28, p < 0.01). The CO bias between AutoEF and VTILVOT was 1.33 l min−1 (95%LOA: -1.72 – 4.38 l min−1) and 1.39 l min−1 (95%LOA -1.34 – 4.12 l min−1) between AutoEF and thermodilution, respectively. AutoEF yielded both significantly lower EF (EFAutoEF: 42.0% (IQR 29.0 — 55.0%) vs. EFTOE Simpson: 55.2% (IQR 40.1 — 70.3%), p < 0.01) and CO values than the reference methods (COAutoEF biplane: 2.30 l min−1 (IQR 1.30 - 3.30 l min−1) vs. COVTI LVOT: 3.64 l min−1 (IQR 2.05 - 5.23 l min−1) and COPAC: 3.90 l min−1 (IQR 2.30 - 5.50 l min−1), p < 0.01)). Conclusions AutoEF correlated moderately with TOE EF determined by the modified Simpson’s method but poorly both with VTILVOT and thermodilution CO. A systematic bias was detected overestimating LV volumes and underestimating both EF and CO compared to the reference methods. Trial registration German Register for Clinical Trials (DRKS-ID DRKS00010666, date of registration: 08/07/2016).

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Section: Discussionmentioning

confidence: 99%

Quantification of left ventricular ejection fraction and cardiac output using a novel semi-automated echocardiographic method: a prospective observational study in coronary artery bypass patients

et al. 2023

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“…Repositioning critically ill patients may be challenging for providers due to patient safety, particularly in the presence of obesity, an inability of the patient to assist, the presence of indwelling invasive devices, and other impediments. The left lateral decubitus position has been shown to improve parasternal and apical views by more than 12% by bringing the heart closer to the chest wall (8, 9). In obese patients, this will decrease the depth of penetration required for the ultrasound waves and ultimately decrease the amount of ultrasound wave attenuation.…”

Section: Body Habitusmentioning

confidence: 99%

Point-of-Care Echocardiography in the Difficult-to-Image Patient in the ICU: A Narrative Review

Grotberg,

McDonald,

2024

Critical Care Explorations

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OBJECTIVES: The objective of this narrative review was to address common obstacles encountered in the ICU to acquiring quality and interpretable images using point-of-care echocardiography. DATA SOURCES: Detailed searches were performed using PubMed and Ovid Medline using medical subject headings and keywords on topics related to patient positioning, IV echo contrast, alternative subcostal views, right ventricular outflow tract (RVOT) hemodynamics, and point-of-care transesophageal echocardiography. Articles known to the authors were also selected based on expert opinion. STUDY SELECTION: Articles specific to patient positioning, IV echo contrast, alternative subcostal views, RVOT hemodynamics, and point-of-care transesophageal echocardiography were considered. DATA EXTRACTION: One author screened titles and extracted relevant data while two separate authors independently reviewed selected articles. DATA SYNTHESIS: Impediments to acquiring quality and interpretable images in critically ill patients are common. Notably, body habitus, intra-abdominal hypertension, dressings or drainage tubes, postoperative sternotomies, invasive mechanical ventilation, and the presence of subcutaneous emphysema or lung hyperinflation are commonly encountered obstacles in transthoracic image acquisition in the ICU. Despite these obstacles, the bedside clinician may use obstacle-specific maneuvers to enhance image acquisition. These may include altering patient positioning, respiratory cycle timing, expanding the subcostal window to include multilevel short-axis views for use in the assessment of RV systolic function and hemodynamics, coronal transhepatic view of the inferior vena cava, and finally point-of-care transesophageal echocardiography. CONCLUSIONS: Despite common obstacles to point-of-care echocardiography in critically ill patients, the beside sonographer may take an obstacle-specific stepwise approach to enhance image acquisition in difficult-to-image patients.

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Focused Ultrasonography in Cardiac Arrest

Kongkatong¹,

Ottenhoff²,

Thom³

et al. 2023

Emergency Medicine Clinics of North America

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Comparison of the Quality of Echocardiography Imaging Between the Left Lateral Decubitus and Supine Positions

Cited by 3 publications

References 24 publications

Quantification of left ventricular ejection fraction and cardiac output using a novel semi-automated echocardiographic method: a prospective observational study in coronary artery bypass patients

Quantification of left ventricular ejection fraction and cardiac output using a novel semi-automated echocardiographic method: a prospective observational study in coronary artery bypass patients

Point-of-Care Echocardiography in the Difficult-to-Image Patient in the ICU: A Narrative Review

Focused Ultrasonography in Cardiac Arrest

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