# Comparing the effects of transthoracic echocardiography and transesophageal echocardiography on stress injury, pain mediators in patients with severe aortic stenosis

## TL;DR

This study compares TTE and TEE in patients with severe aortic stenosis, finding that TEE improves TAVR outcomes with better hemodynamics and reduced stress and pain mediators.

## Contribution

The study provides novel empirical evidence on the comparative benefits of TEE over TTE in reducing stress and pain mediators during TAVR procedures.

## Key findings

- TEE group showed superior postoperative hemodynamics compared to TTE group.
- TEE group had lower levels of stress and pain mediators like IL-1b, IL-6, TNF-a, 5-HT, ET-1, and SP.
- TEE and TTE were equally effective in evaluating aortic root via echocardiography and MSCT.

## Abstract

We compared the differences in the effects of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) on hemodynamics, inflammatory stress response, and pain mediators in patients with severe aortic stenosis (AS).

204 patients with severe AS treated with transcatheter aortic valve replacement (TAVR) in our hospital were selected as the research subjects from January 2022 to February 2024. Among them, 109 patients received TTE (TTE group), and another 95 received TEE (TEE group). Differences in the evaluation effects of preoperative echocardiography and multi-slice helical computed tomography (MSCT) in all patients were compared, and changes in echocardiographic parameters before and after surgery were observed. In addition, the differences in postoperative hemodynamics, cardiac function [brain natriuretic peptide (BNP), cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB)], stress response [superoxide dismutase (SOD), malondialdehyde (MDA)], inflammatory factors [Interleukin-1b/6 (IL-1b/6), tumour necrosis factor-a (TNF-a)], and pain mediators [5-hydroxytryptamine (5-HT), endothelin-1 (ET-1), prostaglandin E2 (PGE2), substance P (SP)] between the observation and TTE groups were compared.

No differences were identified in the evaluation of the aortic root between echocardiography and MSCT (P>0.05). After surgery, parameters such as LVESD and IVST decreased, while LVEF and AVA increased (P<0.05). The TEE group showed superior postoperative hemodynamics to the TTE group (P<0.05). There was no difference in cardiac function between the two groups (P>0.05), but IL-1b, IL-6, TNF-a, 5-HT, ET-1 and SP were lower in the TEE group than in the TTE group, whereas SOD was higher than in the TTE group (P<0.05).

TTE and TEE have an excellent guiding effect on the implementation of TAVR in patients with severe AS, among which TEE is more helpful in improving the effectiveness and safety of TAVR.