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Updated: Mar 30, 2026

Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
Published on: April 18, 2025
Abbreviated right-sided heart echocardiogram and the STOP-Bang questionnaire-a useful relationship for preoperative
Rebecca E Evans1, Joshua Zimmerman2, Sonia Shishido3
1Department of Anesthesiology, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756, USA.
Study Objective:
The aims of this study were to (1) explore the incidence of right-sided heart dysfunction (RHD) and STOP-Bang questionnaire responses consistent with obstructive sleep apnea (OSA) and (2) assess the relationship between patients with STOP-Bang questionnaire responses consistent with OSA and echocardiographic findings suggestive of RHD.
Design:
Observational study.
Setting:
Tertiary academic center preoperative clinic.
Patients:
Two hundred patients presenting for elective surgery to the University of Utah preoperative clinic.
Intervention:
Abbreviated transthoracic right-sided echocardiogram and STOP-Bang questionnaire.
Measurements:
Tricuspid annular plane systolic excursion, tissue Doppler-derived tricuspid lateral annular systolic velocity (S'), and the tricuspid inflow E wave to tricuspid annular tissue Doppler e' wave ratio (E/e') for the presence of RHD, as well as responses to STOP-Bang questionnaire.
Main Results:
A total of 140 echocardiograms were analyzed after exclusion of participants with incomplete STOP-Bang questionnaires and inadequate images. Thirty-five patients (25%) reported 5 or more positive responses to the STOP-Bang questionnaire. Forty-six patients (35%) had abnormal right-sided heart measurements. Of the 35 patients with STOP-Bang scores 5 or greater, 11 (31%) had evidence of RHD. No correlation was observed between STOP-Bang scores and the echocardiography metrics of RHD.
Conclusions:
This preliminary study suggests that there are numerous sources of RHD, among one of which is sleep apnea, and/or the STOP-Bang questionnaire is not a sensitive tool for predicting RHD. We conclude that although the STOP-Bang questionnaire is easy to implement in a preoperative clinical setting, it is not useful in identifying patients at risk for RHD.
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