Cardiothoracic & vascular anesthesia
Poor Agreement Between Preoperative Transthoracic Echocardiography and Intraoperative Transesophageal Echocardiography for Grading Diastolic Dysfunction
Authors' conclusion
There was poor agreement between TTEawake and TEEanesth for grading diastolic dysfunction by a simplified algorithm, with disagreement by ≥1 grade in 54% and by ≥2 grades in 10% of the evaluable cohort.
Study context
- Population
- Patients undergoing cardiac surgery79 with paired measurements
- Participants
- 98 patients
- Comparison
- Awake preoperative TTE (TTEawake) vs intraoperative transesophageal echocardiography (TEE) after anesthesia induction (TEEanesth) for grading diastolic dysfunction
- Outcome
- Grade of diastolic dysfunction (simplified algorithm) by TTEawake and TEEanesth; agreement by weighted κ
Methodological detailspaired measurements, sensitivity analyses
- Paired measurements
- Sensitivity analyses
Main finding
As reported in the abstract
Agreement in grading of diastolic dysfunction (simplified algorithm), TTEawake vs TEEanesth
Disagreement by ≥1 grade
43 (54%) of 79
Disagreement by ≥2 grades
8
10%
Weighted κ (observed agreement beyond chance)
0.35
95% CI 0.19–0.51
Secondary outcomes
| Outcome | Mean difference (95% CI) | |
|---|---|---|
| E'lat (Bland-Altman)TTEawake vs TEEanesth | 0.51 (−0.06 to 1.09) | |
| E/e'lat (Bland-Altman)TTEawake vs TEEanesth | 0.70 (0.07–1.34) | |
| −1012Difference (linear scale) |
- E'lat (Bland-Altman) — Paired measurements outside [−2, +2] boundary of acceptable agreement
- 36% (27%-48%)
- E/e'lat (Bland-Altman) — Paired measurements outside [−2, +2] boundary of acceptable agreement
- 39% (29%-51%)
Sensitivity analyses (TTEawake vs TTEanesth, TTEanesth vs TEEanesth, American Society of Echocardiography (ASE)/European Association of CardioVascular Imaging (EACVI) regrading)
- Results generally robust to sensitivity analyses
Original publication
Poor Agreement Between Preoperative Transthoracic Echocardiography and Intraoperative Transesophageal Echocardiography for Grading Diastolic Dysfunction. Anesth Analg. Published 15 December 2023. doi:10.
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