Con: Strain Imaging Should Not Be a Routine Part of the Intraoperative TEE Exam During Cardiac Surgery

Cios, Theodore J.; Roberts, S. Michael; Klick, John

doi:10.1053/j.jvca.2019.02.041

Cited by 7 publications

(6 citation statements)

References 23 publications

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“…17 However, we used the same software throughout our study, which creates reliable and reproducible results. 30 Last, reliable TTE imaging and GLS measurements depend on a series of hemodynamic snapshots. Since image acquisition was limited to 2 time points, there may be changes over time that went undetected.…”

Section: Discussionmentioning

confidence: 99%

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The Effects of Propofol on Left Ventricular Global Longitudinal Strain

Coleman

Cios

Riela

et al. 2021

Semin Cardiothorac Vasc Anesth

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Objectives To determine if hemodynamic changes secondary to propofol administration are a result of direct myocardial depression as measured by global longitudinal strain (GLS). The authors hypothesized that propofol would cause a significant worsening in GLS, indicating direct myocardial depression. Design Prospective, observational. Setting Endoscopy suite at a single academic medical center. Participants Patients undergoing outpatient, elective endoscopic procedures at an outpatient clinic of a single tertiary care academic medical center. Interventions None. Measurements and Main Results Limited transthoracic echocardiograms were performed before and after patients received propofol for endoscopic procedures. Post-processing measurements included GLS, 2D (dimensional) ejection fraction (2D EF), and 3D EF. Using paired sample Student’s t test, no statistically significant change in GLS, 2D EF, or 3D EF was found despite statistically significant hypotension. In fact, there was a trend toward more negative GLS (improved myocardial function) in patients after receiving propofol. Conclusion We found propofol did not cause a reduction in systolic function as measured by GLS, a sensitive measure of myocardial contractility. Therefore, decreases in blood pressure after a propofol bolus in spontaneously breathing patients are likely due to decreased vascular tone and not impaired left ventricular systolic function. These results should be considered in the management of propofol-induced hypotension for spontaneously breathing patients.

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Section: Discussionmentioning

confidence: 99%

“…Measurement of GLS can be affected in a few different ways. Irregular heart rates or rhythms, age, sex, and LV loading conditions can alter the calculation 17,30.…”

mentioning

confidence: 99%

The Effects of Propofol on Left Ventricular Global Longitudinal Strain

Coleman

Cios

Riela

et al. 2021

Semin Cardiothorac Vasc Anesth

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“…Future studies should focus on exploring these parameters and their influence on patient outcome. Two-dimensional RV strain analysis is a promising technique needing standardization and validation in the context of cardiac and non-cardiac surgery [91,92]. Having the opportunity to distinguish longitudinal, radial, and circumferential contraction [49,55] RV strain analysis allow to differentiate perioperative changes of RV function in different procedures.…”

Section: Future Directionsmentioning

confidence: 99%

Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

Labus

Uhlig

2021

Curr Anesthesiol Rep

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Purpose of Review This review aims to highlight the perioperative echocardiographic evaluation of right ventricular (RV) function with strengths and limitations of commonly used and evolving techniques. It explains the value of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) and describes the perioperative changes of RV function echocardiographers should be aware of. Recent Findings RV dysfunction is an entity with strong influence on outcome. However, its definition and assessment in the perioperative interval are not well-defined. Moreover, values assessed by TTE and TEE are not interchangeable; while some parameters seem to correlate well, others do not. Myocardial strain analysis and three-dimensional echocardiography may overcome the limitations of conventional echocardiographic measures and provide further insight into perioperative cardiac mechanics. Summary Echocardiography has become an essential part of modern anesthesiology in patients with RV dysfunction. It offers the opportunity to evaluate not only global but also regional RV function and distinguish alterations of RV contraction.

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“…As strain is a load-dependent measure of myocardial function, the changes in preload and afterload associated with anesthetics, mechanical ventilation, and surgical fluid shifts can lead to challenges in obtaining serial images under the same physiologic conditions as well as, interpreting absolute values of strain. 7 Speckle tracking strain analysis requires a clear electrocardiogram and sinus rhythm, which in the OR, can be a difficult due to surgical interferences from manipulation of the heart, electrocautery, and cardiac arrhythmias. There are also limitations and delays for software development in strain analysis for TEE as opposed to TTE.…”

Section: Perioperative Use Of Strain Echocardiographymentioning

confidence: 99%

Perioperative Use of Strain Echocardiography

Howard‐Quijano¹

2020

Journal of the American Society of Echocardiography

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Con: Strain Imaging Should Not Be a Routine Part of the Intraoperative TEE Exam During Cardiac Surgery

Cited by 7 publications

References 23 publications

The Effects of Propofol on Left Ventricular Global Longitudinal Strain

The Effects of Propofol on Left Ventricular Global Longitudinal Strain

Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

Perioperative Use of Strain Echocardiography

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