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Transesophageal echocardiography in myocardial ischemia: a review
M Kozàkovà1, C Palombo, G Pittella
1Institute of Clinical Physiology, University of Pisa, Italy.
Insights
Transesophageal echocardiography (TEE) is a valuable tool for diagnosing myocardial ischemia, especially in patients with difficult acoustic windows and during surgery. Emerging applications include assessing right ventricular ischemia and coronary flow reserve (CFR).
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Transesophageal echocardiography (TEE) is utilized for investigating myocardial ischemia.
- Established roles include stress echocardiography for patients with poor transthoracic acoustic windows and intraoperative monitoring.
- Emerging applications in right ventricular ischemia and coronary flow reserve (CFR) assessment are under investigation.
Purpose of the Study:
- To review the established and emerging applications of TEE in the diagnosis and assessment of myocardial ischemia.
- To highlight the potential of TEE in new areas of ischemic heart disease evaluation.
Main Methods:
- Literature review of studies on TEE applications in myocardial ischemia.
- Analysis of evidence for established and novel uses of TEE.
Main Results:
- TEE has a defined role in stress echocardiography and intraoperative ischemia detection.
- Evaluation of right ventricular ischemia/infarction and CFR assessment using TEE are emerging fields.
- Preliminary evidence suggests a significant role for TEE in diagnosing and understanding myocardial ischemia pathophysiology.
Conclusions:
- TEE is a significant diagnostic and pathophysiological assessment tool for myocardial ischemia.
- Further evaluation is needed for emerging TEE applications in ischemic heart disease.
Abstract:
This article reviews established as well as emerging fields in the application of transesophageal echocardiography (TEE) in the investigation of myocardial ischemia. TEE already has a well defined and established role in stress echocardiography in patients with poor transthoracic acoustic window, and in the detection of intraoperative myocardial ischemia in cardiac and noncardiac surgery. The evaluation of right ventricular ischemia and infarction and the assessment of coronary flow reserve (CFR) are relatively new fields in the application of TEE and the potential of this technique has not yet been fully evaluated. The evidence collected and reviewed in this article is still preliminary but it presupposes a significant role of TEE in the diagnosis and pathophysiological assessment of myocardial ischemia.