Tricuspid Annular Plane Systolic Excursion: Comparing Transthoracic to Transesophageal Echocardiography

Abstract

Tricuspid annular plane systolic excursion (TAPSE) represents movement of the lateral annulus of the tricuspid valve toward the apex and denotes right ventricular contractility in the long axis. In transesophageal echocardiography with the probe in the mid-esophagus, TAPSE occurs at a significant angle to the M-mode scan line. The authors describe a novel method to assess TAPSE in 2 dimensions (2D) and compare this with an established method. Prospective cohort study. Tertiary cardiac unit. Forty-three patients scheduled for outpatient transesophageal echocardiography. None. TAPSE was assessed from the transthoracic apical window using M-mode (M-TAPSE) and the mid-esophageal 4-chamber view (2D-TAPSE). To assess 2D-TAPSE, the authors placed an annotation arrow at the junction of the tricuspid annulus and right ventricular free wall during diastole, and a second arrow at this junction at end-systole; 2D-TAPSE represented the distance between the arrows. The mean M-TAPSE was 20.5 (5.9) mm and 2D-TAPSE was 20.5 (5.8) mm. The mean angle between the direction of the lateral tricuspid annular motion and the M-mode scan line from the transthoracic apical window was 19.4 (7.6) degrees and from the mid-esophageal 4-chamber view 62.6 (15.7) degrees (p<0.001). There was a close correlation between M-TAPSE and 2D-TAPSE; r2 = 0.93. Ninety-five percent of 2D-TAPSE were -3.2mm to+3.1mm of M-TAPSE (95% confidence interval -4.0 mm to+4.0 mm). The positive predictive value of 2D-TAPSE<17 mm to predict M-TAPSE<17 was 83%. The negative predictive value of 2D-TAPSE≥17 mm to predict M-TAPSE≥17 was 93%. The intra- and inter-observer variability for 2D-TAPSE was 6.7% and 9.7%, respectively. Transesophageal 2D-TAPSE appeared to be a reliable and simple method to assess right ventricular function, and demonstrated a close correlation with transthoracic M-TAPSE.