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Transesophageal echocardiography: increased risk by repeated attempts to insert the transducer in patients with
W Grosse-Heitmeyer1, R Engberding
1Department of Cardiology, St. Bonifatius-Hospital, Lingen, Germany.
Insights
Multiple attempts during transesophageal echocardiography (TEE) in coronary artery disease (CAD) patients significantly increase heart rate and cause silent myocardial ischemia, indicated by ST-segment depression.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Transesophageal echocardiography (TEE) is crucial for diagnosing cardiac conditions.
- The impact of multiple transducer insertion attempts on patients with coronary artery disease (CAD) is not well understood.
Purpose of the Study:
- To investigate if repeated transducer insertion attempts during TEE increase risks in CAD patients.
- To correlate physiological changes with exercise ECG and coronary angiography findings.
Main Methods:
- TEE was performed on 45 CAD patients.
- Nine patients required two or more insertion attempts.
- Heart rate, blood pressure, and ST-segment changes were monitored and correlated with ECG and angiography.
Main Results:
- Heart rate significantly increased with more insertion attempts (p < 0.005).
- ST-segment depression, indicative of silent myocardial ischemia, increased significantly with insertion attempts (p < 0.01).
- One patient with normal angiography showed no ST-segment depression.
Conclusions:
- Multiple TEE transducer insertion attempts can induce significant physiological stress in CAD patients.
- These attempts are associated with silent myocardial ischemia, even without patient-reported angina.
- TEE procedures in CAD patients require careful consideration of insertion attempts.
Abstract:
The question of whether several attempts at transducer insertion increase the risk of performing transesophageal echocardiography (TEE) in patients with coronary artery disease (CAD) has not been addressed to date. In the course of performing TEE in 45 patients with CAD, two or more attempts to insert the transducer were necessary in 9 cases. During various attempts, heart rate, blood pressure and ST-segment depression were recorded and correlated with the findings of the exercise electrocardiogram (ECG) and coronary angiography. Insertion was successful in six patients after two attempts and in three other patients after three, four, and five attempts, respectively. Heart rate rose significantly (p < 0.005) with the increase of insertion attempts. In one patient, it continued to rise at the fourth attempt, reaching 216% compared with the initial heart rate. Systolic blood pressure rose by 5%, whereas there was hardly any change in diastolic blood pressure. As the number of insertion attempts increased, we recorded a continuous ST-segment depression in eight patients with angiographic changes of the coronary artery system. The depression was already significant at the first attempt (p < 0.05). Compared with the initial reading (0.053 mV), the increase was 335% (p < 0.01) after the second attempt (0.231 mV). One patient whose angiographic findings were normal had no ST-segment depression during TEE. In all eight patients with CAD ST-segment depression during TEE was > 0.2 mV. Since none of the patients complained of angina pectoris, the ST-segment depressions satisfied all the criteria of silent myocardial ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)