Key result
Mid-esophageal bicaval view fails to significantly improve left septal pouch detection versus short-axis view.
Why the study?
Does the mid-esophageal bicaval view improve the detection and measurement of atrial septal pouches compared to the short-axis view in patients undergoing TEE?
Cross-Sectional (n=146)
Does the mid-esophageal bicaval view improve the detection and measurement of atrial septal pouches compared to the short-axis view in patients undergoing TEE?
The mid-esophageal bicaval view is preferable to the short-axis view for diagnosing and measuring left atrial septal pouches during TEE.
Non-significant trend favors bicaval view for pouch detection; leaves open optimal TEE imaging in cross-sectional data.
BACKGROUND: Recent studies suggest that the left-sided septal pouch (SP) may increase the risk of cryptogenic stroke and act as an arrhythmogenic substrate. The aim of this study was to compare two transesophageal echocardiography (TEE) projections of the interventricular septum: mid-esophageal bicaval and short-axis views toward evaluating their ability to detect SPs. MATERIALS AND METHODS: A total of 146 patients with both bicaval and short-axis TEE views were included in this study. The presence of SPs was determined, and they were evaluated for morphology. RESULTS: Irrespective of TEE projection view, the left SP was detected in 74 cases (50.7%), right SP in 16 cases (11.0%), and double in one case (0.7%). Agreement between both projections occurred in 119 cases (81.5%) with a weighted kappa coefficient of 0.68 (good agreement). We detected more left SPs from the bicaval view compared to the short-axis view; however, the observed difference was statistically insignificant (72 vs 59, P = .13). The detection of right SPs was higher in the short-axis view, but also statistically insignificant (9 vs 13, P = .38). Bland-Altman analysis revealed a significant difference in the left SP depth with higher values in the bicaval than short-axis view (systematic difference = 1.17 mm, LoA: -4.88-7.22 mm, P = .02, ICC = 0.58). CONCLUSIONS: The mid-esophageal bicaval view should be preferable over mid-esophageal short-axis view of interatrial septum for the diagnosis and measurement of the left SP.
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Hołda et al. (2018) conducted a cross-sectional in Patients undergoing transesophageal echocardiography (n=146). Mid-esophageal bicaval view vs. Mid-esophageal short-axis view was evaluated on Detection of left septal pouches (p=0.13). The mid-esophageal bicaval view detected more left septal pouches than the short-axis view (49.3% vs 40.4%), though the difference was not statistically significant (P=0.13).
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