Regional Versus Global Measurements of Right Ventricular Strain Performed in the Operating Room With Transesophageal Echocardiography

Objective: To compare regional and global measures of right ventricular (RV) strain in patients undergoing intraoperative transesophageal echocardiography (TEE). Design: Prospective, nonrandomized, observational study. Setting: Single tertiary-level, university hospital. Participants: The study comprised 48 patients undergoing intraoperative TEE. Interventions: None. Measurements and Main Results: A global RV strain measurement (termed RV 5-wall strain [RV 5WS]) was calculated by averaging the longitudinal strain calculated from multiple TEE views. This global strain measurement was compared with the more standard regional strain measurements obtained in a single 4-chamber view (RV free-wall strain [RV FWS] and RV global longitudinal strain [RV GLS]) and with traditional measures of RV function. Regional and global strain measurements were feasible in the operating room. RV FWS and RV GLS strongly correlated with RV 5WS (r=0.86 and 0.87, respectively) with no significant bias and limits of agreement of approximately 5% to 5%. RV FWS and RV GLS were even more closely correlated with each other (r=0.99) with no significant bias and limits of agreement less than 2% to 2%. Both regional and global RV strain measurements showed a high sensitivity (RV FWS 94%; RV GLS 94%; RV 5WS 89%) and moderate specificity (RV FWS 70%; RV GLS 67%; RV 5WS 63%) for RV dysfunction based on a reference standard of 3-dimensional RV ejection fraction. Conclusions: Both regional and global RV strain measurements are feasible in the operating room with TEE. Regional and global measures of RV function correlate well and are sensitive indicators of RV dysfunction. (C) 2019 Elsevier Inc. All rights reserved.