Anaesthetist-led perioperative transthoracic echocardiography service: a clinical audit

Growing enthusiasm for transthoracic echocardiography (TTE) among non-cardiac specialties has led to the development of multiple focused TTE protocols in recent years. The role of echocardiography in anaesthesiology is also evolving; an increasing number of anaesthetic units in Hong Kong have established or devised anaesthetist-led TTE services to fast-track patients who require focused TTE in the perioperative period. This study explored the clinical impact of anaesthetist-led perioperative TTE on the perioperative management of patients undergoing non-cardiac surgery in Hong Kong.

A retrospective study was conducted in a single-centre anaesthetic unit in Hong Kong. Data from November 2019 to October 2024 were obtained for adult patients undergoing non-cardiac surgery who received TTE performed by anaesthetists and TTE performed or interpreted by cardiologists. Four perioperatively significant parameters were compared, including agreement on left ventricular ejection fraction (LVEF), tricuspid regurgitation pressure gradient, and the presence of aortic or mitral stenosis. Cohen's kappa analysis was used to measure interobserver agreement for binary/categorical variables (eg, presence of valve pathology); Bland-Altman plots and intraclass correlation coefficients (ICCs) were used to measure agreement for continuous variables.

In total, 405 patients were identified, of whom 34 were included. Cohen's kappa values were 1 (P<0.001) for diagnosing mitral stenosis and 0.87 (P<0.001) for diagnosing aortic stenosis. The ICC for LVEF was 0.61 (95% confidence interval [95% CI]=0.35-0.78; P<0.001). The ICC for tricuspid regurgitation pressure gradient was 0.7 (95% CI=0.41-0.86; P<0.001).

The results show reasonable agreement between anaesthetist-performed echocardiograms and the 'gold standard' across all four perioperatively significant parameters.