Hemodynamics derived from transesophageal echocardiography
- Elyse Foster, MD
Elyse Foster, MD
- Professor of Clinical Medicine
- University of California, San Francisco
Transesophageal echocardiography (TEE) can rapidly provide a comprehensive array of hemodynamic information. This is of particular importance in the critical care setting, where patients are often obtunded and mechanically ventilated; TEE may aid in differentiating among causes of hypotension, etiologies of dyspnea, and causes of chest pain. To reliably and safely apply TEE to critical care, skill, experience, and multidisciplinary approach are essential. A working relationship among intensivists, anesthesiologists, and cardiologists is an integral part of every successful critical care TEE program.
This topic will review the hemodynamic information which can be obtained during TEE. The general indications for TEE, along with its use in specific clinical situations, are discussed separately. (See "Transesophageal echocardiography: Indications, complications, and normal views" and "Transesophageal echocardiography in the evaluation of the left ventricle" and "Transesophageal echocardiography in the evaluation of mitral valve disease" and "Transesophageal echocardiography in the evaluation of aortic valve disease".)
Hemodynamic variables that are derived from TEE are comprehensive enough to provide accurate information ; variables that can be estimated include:
●Left ventricular (LV) filling pressure
- Nagueh SF, Appleton CP, Gillebert TC, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009; 22:107.
- Bouchard A, Blumlein S, Schiller NB, et al. Measurement of left ventricular stroke volume using continuous wave Doppler echocardiography of the ascending aorta and M-mode echocardiography of the aortic valve. J Am Coll Cardiol 1987; 9:75.
- Haites NE, McLennan FM, Mowat DH, Rawles JM. How far is the cardiac output? Lancet 1984; 2:1025.
- Lim DC, Redberg RF, Foster E, et al. Stroke distance is independent of body surface area. J Am Soc Echo 1993; 6:S34.
- Urbanowicz JH, Shaaban MJ, Cohen NH, et al. Comparison of transesophageal echocardiographic and scintigraphic estimates of left ventricular end-diastolic volume index and ejection fraction in patients following coronary artery bypass grafting. Anesthesiology 1990; 72:607.
- Muhiudeen IA, Kuecherer HF, Lee E, et al. Intraoperative estimation of cardiac output by transesophageal pulsed Doppler echocardiography. Anesthesiology 1991; 74:9.
- Darmon PL, Hillel Z, Mogtader A, et al. Cardiac output by transesophageal echocardiography using continuous-wave Doppler across the aortic valve. Anesthesiology 1994; 80:796.
- Katz WE, Gasior TA, Quinlan JJ, Gorcsan J 3rd. Transgastric continuous-wave Doppler to determine cardiac output. Am J Cardiol 1993; 71:853.
- Parra V, Fita G, Rovira I, et al. Transoesophageal echocardiography accurately detects cardiac output variation: a prospective comparison with thermodilution in cardiac surgery. Eur J Anaesthesiol 2008; 25:135.
- Møller-Sørensen H, Graeser K, Hansen KL, et al. Measurements of cardiac output obtained with transesophageal echocardiography and pulmonary artery thermodilution are not interchangeable. Acta Anaesthesiol Scand 2014; 58:80.
- Griffin BP, Hore P, Davison K, et al. Determination of cardiac output with single and biplane transesophageal echocardiography. J Am Coll Cardiol 1991; 17:35A.
- Hozumi T, Shakudo M, Applegate R, Shah PM. Accuracy of cardiac output estimation with biplane transesophageal echocardiography. J Am Soc Echocardiogr 1993; 6:62.
- Cohen GI, Pietrolungo JF, Thomas JD, Klein AL. A practical guide to assessment of ventricular diastolic function using Doppler echocardiography. J Am Coll Cardiol 1996; 27:1753.
- Hatle L. Doppler echocardiographic evaluation of diastolic function in hypertensive cardiomyopathies. Eur Heart J 1993; 14 Suppl J:88.
- Labovitz AJ, Pearson AC. Evaluation of left ventricular diastolic function: clinical relevance and recent Doppler echocardiographic insights. Am Heart J 1987; 114:836.
- Kuecherer HF, Foster E. Hemodynamics by transesophageal echocardiography. Cardiol Clin 1993; 11:475.
- Nishimura RA, Abel MD, Hatle LK, Tajik AJ. Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography. Effect of different loading conditions. Circulation 1990; 81:1488.
- Kuecherer HF, Muhiudeen IA, Kusumoto FM, et al. Estimation of mean left atrial pressure from transesophageal pulsed Doppler echocardiography of pulmonary venous flow. Circulation 1990; 82:1127.
- Kuecherer HF, Kusumoto F, Muhiudeen IA, et al. Pulmonary venous flow patterns by transesophageal pulsed Doppler echocardiography: relation to parameters of left ventricular systolic and diastolic function. Am Heart J 1991; 122:1683.
- Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29:277.
- Rossvoll O, Hatle LK. Pulmonary venous flow velocities recorded by transthoracic Doppler ultrasound: relation to left ventricular diastolic pressures. J Am Coll Cardiol 1993; 21:1687.
- Klein AL, Stewart WJ, Bartlett J, et al. Effects of mitral regurgitation on pulmonary venous flow and left atrial pressure: an intraoperative transesophageal echocardiographic study. J Am Coll Cardiol 1992; 20:1345.
- Kusumoto FM, Muhiudeen IA, Kuecherer HF, et al. Response of the interatrial septum to transatrial pressure gradients and its potential for predicting pulmonary capillary wedge pressure: an intraoperative study using transesophageal echocardiography in patients during mechanical ventilation. J Am Coll Cardiol 1993; 21:721.
- HEMODYNAMIC VARIABLES
- Cardiac output
- Left ventricular and atrial filling pressures
- - Doppler mitral inflow velocity
- - Pulmonary venous flow
- - Mitral regurgitation continuous-wave Doppler echocardiography
- Left ventricular and atrial chamber sizes (preload)
- - Hypovolemia
- - Hypervolemia
- - Intra-atrial septal motion