Abstract 16722: Comparison of Tricuspid Annular Plane Systolic Excursion to Fractional Area Change for Evaluation of Right Ventricular Systolic Function: Systematic Review and Meta-analysis

Abstract

Introduction: Right ventricular (RV) systolic function is prognostically important, but its assessment by echocardiography remains challenging. Tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) have been evaluated as echocardiographic indices for RV ejection fraction (RVEF), but their correlation with the gold-standard cardiac magnetic resonance imaging (CMRI) remains unclear. The aim of this meta-analysis is to pool and compare data from all studies that evaluated reliability of TAPSE and FAC in comparison to CMRI-derived RVEF. Hypothesis: We assessed the hypothesis that FAC is superior to TAPSE as an echocardiographic index for measurement of RV systolic function. Methods: A systematic literature search of 4493 potentially relevant citations from PubMed, and EMBASE databases yielded 25 eligible studies. The means of TAPSE and FAC, CMRI-derived RVEF, and correlation coefficients were pooled from each study for analysis. Results: A total of 25 studies were included in the final analysis, with a total of 1,858 patients who underwent 2D-echocardiography and cardiac MRI. FAC, compared to TAPSE, exhibited numerically superior correlation to CMRI RVEF (R2 = 0.63, and R2 = 0.15 respectively). Subgroup analysis revealed that FAC’s correlation was also numerically superior in patients with reduced right ventricular ejection fraction of less than 45% (R2 = 0.4 and R2 = 0.17, respectively). In patients with pulmonary hypertension (PH), TAPSE and FAC had mean correlation coefficients of 0.57±0.1 and 0.60±0.13, and were not statistically different (p=0.85). Conclusions: FAC is superior to TAPSE as an echocardiographic index for measurement of RV systolic function, even in patients with reduced right ventricular ejection fraction, but not in patients with PH. The adaptation to increased afterload of PH likely culminates in distinct and asymmetric patterns of RV dysfunction, which are not well assessed by FAC or TAPSE.