Tricuspid annular plane systolic excursion (TAPSE) is not an appropriate parameter for the evaluation of right ventricular systolic function after lung transplant

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. Tricuspid annular plane systolic excursion (TAPSE) is a widely used parameter for the assessment of right ventricular (RV) systolic function in candidates for lung transplant (LT). However, its accuracy after surgery is not well established. In our study, we aim to evaluate the feasibility of TAPSE after LT and compare it with other classic parameters of RV function. Methods. 144 patients underwent LT between January 2014 and June 2017 in our center. Mean age was 55 years (65 % men). Double LT was performed in 65%, being most common etiology pulmonary fibrosis followed by chronic pulmonary obstructive disease. 9% of LT candidates had severe pulmonary hypertension (PH), defined as mean pulmonary artery pressure (PAP) over 45 mmHg on right heart catheterization. We retrospectively analyzed echocardiographic studies at baseline and 4 weeks after LT in 94 patients. Nine of them had prior severe pulmonary hypertension. We measured RV fractional area change (FAC) and systolic displacement of tricuspid annulus-TAPSE as main parameters of RV systolic function, as well as right atrium (RA) area. Results. We found a significant improvement in RV FAC (39 ± 9% vs. 44 ± 6%, p < 0.001) and a reduction in RA area (16 ± 6 cm2 vs. 12 ± 5 cm2; p < 0.001) after lung transplant in the global study group. This was remarkably significant when prior severe pulmonary hypertension was present (RV FAC 24 ± 9% vs. 43 ± 6%, RA area 27 ± 8 cm2 vs. 14 ± 4 cm2; p < 0.000). However, postoperative TAPSE was significantly lower (21 ± 3 mm vs. 17 ± 2 mm; p < 0.000), and it did not show any significant change in the PH subgroup (p = 0.89). We found a good correlation between TAPSE and RV FAC on pre-transplant echocardiographic study (r = 0.76; p < 0.000), whereas this relation did not remain after LT (r = 0.26; p 0.06). Conclusion. Right ventricular systolic function globally improved after LT, and this is particularly pronounced in candidates with severe PH. In contrast, TAPSE paradoxically deteriorates on post-surgery echocardiogram. According to our findings, TAPSE may not be a reliable parameter for the assessment of RV systolic function after lung transplant.