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Anesth Analg 2002;94:302-309
© 2002 International Anesthesia Research Society

CARDIOVASCULAR ANESTHESIA

Transesophageal Echocardiography Interpretation: A Comparative Analysis Between Cardiac Anesthesiologists and Primary Echocardiographers

Joseph P. Mathew, MD, Manuel L. Fontes, MD, Susan Garwood, MD, Elizabeth Davis, LPN, RDCS, William D. White, MPH, Gerard McCloskey, MD, Jane C.K. Fitch, MD, Sherif Afifi, MD, David L. Lee, MD, Phillip Kraker, DO, Terence D. Rafferty, MD, Paul G. Barash, MD, Linda Gillam, MD, and Edward Prokop, MD

Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina and Yale University School of Medicine, New Haven, Connecticut; Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Cardiac Diagnostic Unit, Hospital of Saint Raphael, New Haven, Connecticut

Address correspondence and request for reprints to Joseph P. Mathew, MD, Box 3094, Duke University Medical Center, Durham, NC 27710. Address e-mail to mathe014{at}mc.duke.edu

Diagnostic interpretation of intraoperative transesophageal echocardiography (TEE) examinations may vary, particularly when the echocardiographer is also the anesthesiologist. We therefore evaluated the concordance of TEE interpretation as part of a process of continuous quality improvement (CQI). Ten cardiac anesthesiologists participating in a CQI program conducted 154 comprehensive TEE examinations, each consisting of 16 major fields describing cardiac anatomy and function. These examinations were subsequently interpreted off-line by two primary echocardiographers (a radiologist and a cardiologist). Agreement was assessed using the {kappa} coefficient and percent agreement. Overall {kappa} and percent agreement were 0.58 and 83% for anesthesiologists versus radiologist, 0.57 and 80% for anesthesiologists versus cardiologist, and 0.60 and 82% for radiologist versus cardiologist. Anesthesiologists with longer than 5 yr of TEE experience had higher levels of agreement with the radiologist when assessing the aorta, right atrium, pulmonary vein flow, transmitral flow, and fractional area change. Cardiac anesthesiologists supported by a CQI program interpret TEE examinations at a level comparable with physicians whose primary practice is echocardiography. Thus, the anesthesiologist and the intraoperative echocardiographer need not be mutually exclusive.

IMPLICATIONS: Interpretation of intraoperative transesophageal echocardiograms can be reliably performed by cardiac anesthesiologists.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2002 by the International Anesthesia Research Society.