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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

The Effect of Obesity on TTE Imaging During Pregnancy

Abstract Number: T2A-6
Abstract Type: Original Research

Emily Williamson M.D.1 ; James Lovato M.S.2; Kenneth E Nelson M.D.3

Introduction: With only basic sonography training, transthoracic echocardiography (TTE) can be utilized by anesthesiologists during pregnancy to obtain valuable information regarding a parturient’s myocardial function, valvular function, and volume status. Although TTE is gaining in popularity, studies are lacking that investigate the utility of TTE during pregnancy, including pregnancies complicated by obesity. The aim of this study was to establish the feasibility of performing TTE on parturients, and to determine the effect of obesity on the ability to perform the TTE exams.

Methods: We performed a prospective study using two investigators (one resident and one attending anesthesiologist) to perform TTE on parturients with no known heart disease, utilizing a single view (parasternal long axis). A novel grading scale was developed (1 = complete visualization of structures; 2 = incomplete visualization; 3 = very limited visualization) and the scale was applied to nine TTE parameters (aortic valve, mitral valve, LV, septum, RV, aortic root, LA, inferior wall, and volume status). Each TTE exam was timed, with the investigator ending the study when views of all nine parameters were optimized. To assess the association of BMI with study duration, a mixed model with a performing physician random effect was run to account for the correlation within performing physician. Study quality was defined as excellent only if all parameters were measured as Grade 1. Logistic regression was used to assess the association of BMI with study duration and quality.

Results: Two hundred patients were enrolled and 197 were evaluated. One patient was unknowingly studied by both sonographers, and two were enrolled below the predetermined gestational age cutoff of 28 weeks. Mean BMI was 36.0 kg/m2 (SD 10.3; range 19.2-79.5). Mean time required to perform the TTE exam was 70.2 seconds (SD 59.8; range 18-424). Association of BMI with study duration, all data: For each unit increase in BMI, study duration increased by 1.57 seconds (95% CI 0.78 to 2.36) p=0.0001. Data with BMI≤40: For each unit increase in BMI, study duration increased by 0.12 seconds (95% CI -1.51 to 1.75) p=0.89. Association of BMI with study quality, all data: For each unit increase in BMI, the odds of a non-excellent study increased 6.6% (95% CI 3.0 to 10.3) p=0.0003. Data with BMI≤40: For each unit increase in BMI, the odds of a non-excellent study increased 5.6% (95% CI -1.2 to 12.8) p=0.11.

Conclusion: Performance of TTE on parturients by anesthesiologists is feasible, with good quality parasternal long axis views being obtained in a short period of time by investigators with minimal prior sonography experience. Additionally, obesity only has a negative impact on the quality and efficiency of the parasternal long axis view at extremely high BMIs. All parturients with a BMI of 40 or less were equally likely to achieve an efficient, high quality exam.

SOAP 2018