Heart Chambers
Conditions
Keywords
Cardiac Imaging, Cardiac Chamber Dimensions, General Anesthesia, Cardiac Surgery, Imaging Agreement, Diagnostic Accuracy, Perioperative Care, Echocardiography
Brief summary
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_TESTTransthoracic 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 performed intraoperatively under general anesthesia as part of routine care.
Sponsors
Sunnybrook Health Sciences Centre
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Correlation between preoperative TTE and intraoperative TEE measurements | Within 2 weeks prior to surgery and during surgery | The correlation between preoperative transthoracic echocardiography (TTE) and intraoperative transesophageal echocardiography (TEE) measurements of cardiac chamber dimensions, including left ventricular internal dimensions, left atrial volume, and right atrial dimensions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Impact of general anesthesia on correlation between TTE and TEE. | Within 2 weeks prior to surgery and during surgery | Impact of physiological changes induced by general anesthesia on the correlation between TTE and TEE measurements. |
| Impact of PEEP on correlation between TTE and TEE | Within 2 weeks prior to surgery and during surgery | Impact of physiological changes induced by PEEP on the correlation between TTE and TEE measurements. |
| Impact of cardiac conditions on correlation between TTE and TEE. | Within 2 weeks prior to surgery and during surgery | Impact of cardiac conditions (e.g., COPD, hypertension, history of atrial fibrillation) on the correlation between TTE and TEE measurements. |
Countries
Canada
Contacts
Primary ContactJacobo Moreno Garijo, MD, PhD
Backup ContactLilia Kaustov, PhD
Outcome results
None listed