Tricuspid Annular Displacement Research Articles

Feasibility Value of Right Ventricular Longitudinal Shortening Fraction and the Prognostic Implications in Patients With Heart Transplantation.

Right ventricular longitudinal shortening fraction (RVLSF) is a 2-dimensional speckle tracking echocardiography parameter based on tricuspid annular displacement analysis that could be used to assess right ventricular (RV) systolic function. The value of RVLSF in the assessment of RV systolic function in recipients of heart transplantation (HT) and whether RVLSF can replace strain parameters remains unknown. A total of 153 adult patients who underwent HT were consecutively enrolled in this prospective longitudinal study. All subjects were examined by conventional transthoracic 2-dimensional echocardiography and 2-dimensional speckle tracking echocardiography to evaluate the RV end-diastolic basal diameter, RV end-diastolic area, fractional area change, peak systolic velocity of tricuspid annulus, tricuspid annular plane systolic excursion, RV free wall strain, and RVLSF. Cox proportional hazards regression was used to test if the parameters of interest had independent prognostic value for adverse outcome prediction in patients who underwent HT. A significant positive correlation was found between the measurements of RVLSF and RV free wall strain (r=0.927, P<0.001). Compared with the event-free group, the adverse outcome group displayed reduced RVLSF and RV free wall strain and higher age (P<0.001, <0.001, =0.016, respectively) in patients who underwent HT. RVLSF and RV free wall strain were independently associated with poor prognosis in multivariable analysis (both P<0.001). RVLSF assessment provides an effective evaluation of RV longitudinal systolic function in the transplanted hearts and has prognostic value for adverse outcomes in patients undergoing HT.

Diagnostic and prognostic value of echocardiography in pulmonary hypertension: an umbrella review of systematic reviews and meta-analyses

BackgroundThe role of echocardiography in the diagnostic and prognostic assessment of pulmonary hypertension (PH) has been widely studied recently. However, these findings have not undergone normative evaluation and may provide confusing evidence for clinicians. To evaluate and summarize existing evidence, we performed an umbrella review.MethodsSystematic reviews and meta-analyses were searched in PubMed, Embase, Web of Science, and Cochrane Library from inception to September 4, 2022. The methodological quality of the included studies was assessed using Assessment of Multiple Systematic Reviews (AMSTAR), and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the quality of evidence.ResultsThirteen meta-analyses (nine diagnostic and four prognostic studies) were included after searching four databases. The methodological quality of the included studies was rated as high (62%) or moderate (38%) by AMSTAR. The thirteen included meta-analyses involved a total of 28 outcome measures. The quality of evidence for these outcomes were high (7%), moderate (29%), low (39%), and very low (25%) using GRADE methodology. In the detection of PH, the sensitivity of systolic pulmonary arterial pressure is 0.85–0.88, and the sensitivity and specificity of right ventricular outflow tract acceleration time are 0.84. Pericardial effusion, right atrial area, and tricuspid annulus systolic displacement provide prognostic value in patients with pulmonary arterial hypertension with hazard ratios between 1.45 and 1.70. Meanwhile, right ventricular longitudinal strain has independent prognostic value in patients with PH, with a hazard ratio of 2.96–3.67.ConclusionThe umbrella review recommends echocardiography for PH detection and prognosis. Systolic pulmonary arterial pressure and right ventricular outflow tract acceleration time can be utilized for detection, while several factors including pericardial effusion, right atrial area, tricuspid annular systolic displacement, and right ventricular longitudinal strain have demonstrated prognostic significance.Trial registrationPROSPERO (CRD42022356091), https://www.crd.york.ac.uk/prospero/.

True relationship between tricuspid annular motion and velocity displacement components: Potential role in assessing right ventricular decoupling.

Although measures of longitudinal displacement of the tricuspid annulus measured by M-mode as tricuspid annular systolic plane excursion (TAPSE) and systolic velocity by tissue Doppler imaging (TA TDI s) are routinely used for assessment of right ventricular (RV) systolic function; these measures describe different phenomena and should not be used interchangeably. Previously published data was used to determine the individual relationship between TAPSE and TA TDI s with increasing pulmonary artery systolic pressures (PASP). In this retrospective analysis, 488 patients were divided into 2 groups based on TAPSE (Group 1:<1.8cm and Group 2: ≥1.8cm). A robust correlation (R=.79) between TAPSE and TA TDI s noted for the entire population. However, a statistically lower correlation (R=.43) was seen between Group 1 and Group 2 (R=.65; p<.0047). With increasing pulmonary pressures, only PASP (p<.0001) and TA TDI s (p<.0001) discriminated between low and normal TAPSE/PASP values. Suggesting that a TA TDI s/PASP ratio would be most useful than TAPSE/PASP with a specificity of 80%. Significant differences exist between TAPSE and TA TDI s, particularly at low TAPSE values with increased PASP, were uncoupling occurs. Our data seems to suggest that TA TDI s/PASP would be most useful than TAPSE/PASP ratio. Future studies should address, if abnormalities in the material properties along the RV free wall account for these differences seen between TAPSE and TA TDI s.

Interchangeability of right ventricular longitudinal shortening fraction assessed by transthoracic and transoesophageal echocardiography in the perioperative setting: A prospective study.

Conventional transthoracic (TTE) and transoesophageal echocardiography (TEE) parameters assessing right ventricle (RV) systolic function are daily used assuming their clinical interchangeability. RV longitudinal shortening fraction (RV-LSF) is a two-dimensional speckle tracking parameter used to assess RV systolic function. RV-LSF is based on tricuspid annular displacement analysis and could be measured with TTE or TEE. The aim of the study was to determine if RV-LSFTTE and RV-LSFTEE measurements were interchangeable in the perioperative setting. Prospective perioperative TTE and TEE echocardiography were performed under general anesthesia during scheduled cardiac surgery in 90 patients. RV-LSF was measured by semi-automatic software. Comparisons were performed using Pearson correlation and Bland-Altman plots. RV-LSF clinical agreement was determined as a range of -5 to 5%. Of the 114 patients who met the inclusion criteria, 90 were included. The mean preoperative RV-LSFTTE was 20.4 ± 4.3 and 21.1 ± 4.1% for RV-LSFTEE. The agreement between RV-LSF measurements was excellent, with a bias at -0.61 and limits of agreement of -4.18 to 2.97 %. All measurements fell within the determined clinical agreement interval in the Bland-Altman plot. Linear regression analysis showed a high correlation between RV-LSFTTE and RV-LSFTEE measurement (r = 0.9; confidence interval [CI] 95%: [0.87-0.94], p < 0.001). RV-LSFTTE and RV-LSFTEE measurements are interchangeable, allowing RV-LSF to be a helpful parameter for assessing perioperative changes in RV systolic function. NCT05404737. https://www.clinicaltrials.gov/ct2/show/NCT05404737.

Changes in echocardiographic parameters of the donor's heart before and after heart transplantation and their relationship with post-transplant survival.

BackgroundHeart transplantation is now widely performed in China, but the current entry criteria for heart transplantation donors are simple and lack reliable standards; there are still no studies on the effect of preoperative echocardiographic parameters of heart transplantation donors on the prognosis of the recipient. Therefore, the aim of this study is twofold: (I) to observe the characteristics of changes in echocardiographic parameters of the donor’s heart before and after heart transplantation and (II) to study the relationship between the changes in echocardiographic parameters of the donor’s heart pre- and post-transplant and transplant recipient survival.MethodsA total of 29 patients who underwent orthotopic heart transplant in our hospital from October 2016 to October 2019 were enrolled in this study. All recipients were followed up until April 2020. Echocardiographic data were collected pre-transplantation (donor) and at 1 week and 1 month post-transplant (recipient).ResultsCompared with the pretransplanted donor’s heart, there was an increase in the interventricular septal diameter, left ventricular posterior wall diameter, right atrium diameter and right ventricular diameter, while a decrease was found in the tricuspid annular systolic displacement and tricuspid annular peak systolic velocity at 1 week post-transplant. The survival curve showed that the postoperative survival time in the right atrium/ventricle ≥32 mm group was better than that in the right atrium/ventricle <32 mm group. The survival curve also showed that the postoperative survival time in the right atrium/ventricle enlargement <2 mm group was better than that in the right atrium/ventricle enlargement ≥2 mm group.ConclusionsIn the early post-transplant period, ventricular myocardial thickening, right heart enlargement and a decrease in right heart function were observed in the post-transplanted heart compared to the pretransplanted donor’s heart. Postoperative survival was higher among heart transplant patients who received a heart with right atrium/ventricle ≥32 mm. Postoperative survival was lower among heart transplant patients whose right atrium/ventricle was dilated ≥2 mm at 1 month postoperatively compared with the pretransplanted donor’s heart.

Preload Dependency of 2D Right Ventricle Speckle Tracking Echocardiography Parameters in Healthy Volunteers: A Prospective Pilot Study.

(1) Background: Right ventricular (RV) strain parameters derived from the analysis of the tricuspid annular displacement (TAD) are emergent two-dimensional speckle tracking echocardiography (2D-STE) parameter used for the quantitative assessment of RV systolic function. Few data are available regarding 2D-STE parameters and their dependency on RV preload. Our aim was to evaluate the effect of an acute change in RV preload on 2D-STE parameters in healthy volunteers. (2) Methods: Acute modification of RV preload was performed by a fluid challenge (FC): an infusion of 500 mL of 0.9% sodium chloride was given over 5 min in supine position. Preload dependency (responder group) was confirmed by a stroke volume increase of at least 10% measured by echocardiography. (3) Results: Among 32 healthy volunteers, 19 (59%) subjects were classified as non-responders and 13 (41%) as responders. In the responder group, the tricuspid annular plane systolic excursion (TAPSE) significantly increased (20 (20–23.5) mm to 24 (20.5–26.5) mm; p = 0.018), while RV strain parameters significantly decreased after FC: −23.5 ((−22.3)–(−27.3))% to −25 ((−24)–(29.6))%; p = 0.03) for RV free wall longitudinal strain and −22.8 ((−20.4)–(−30.7))% to −23.7 ((−21.2)–(−27))%; p = 0.02) for RV four-chamber longitudinal strain. 2D-STE parameters derived from the TAD analysis were not influenced by the FC (all p > 0.05). (4) Conclusions: In young, healthy volunteers, RV strain parameters and TAPSE are preload dependent, while TAD parameters were not. The loading conditions must be accounted for when evaluating RV systolic function by 2D-STE parameters.

Right ventricular free wall contractility in subcostal views: A proof-of-concept study to assess right ventricular systolic function.

Normal right ventricular (RV) function has been traditionally assessed from the apical window. However, in several patients the subcostal window is the only available acoustic. Given the intricate functional and mechanical inter-dependence between longitudinal tricuspid annular (TA) displacement and RV free wall contractility (RVFW), we studied the utility of RVFW inward motion using both M-mode and velocity with tissue Doppler imaging (TDI) from the subcostal transthoracic view. If a TAPSE value ≥ 2cm is used to identify normal RV function, an RVFW M-mode value>.8cm, TA TDI s' velocity>.06cm/s and TA TDI e' velocity value>.05cm/s identify normal RV systolic function. Furthermore, ROC curve analysis for the RVFW M-mode showed an area under the curve (AUC) of .753 (95% CI: .604-.868) with a cut-off value>.8, sensitivity 75% and specificity 73%; for TA TDI s' AUC at .822 (95% CI: .681-.919) with a cut-off value>.06, sensitivity 75% and specificity 77% and for TA TDI e' the AUC was .771 (95% CI: .624-.882) with a cut-off value>.05, sensitivity 90% and specificity 46%. Reproducibility of repeat RVFW M-mode, TDI s' and e' measurements was good with strong inter-rater agreement (Kappa>.8). The subcostal window appears useful for assessing RV systolic function. Additional studies are now required to prospectively use these measures in the routine evaluation of RV systolic function particularly in patients with suboptimal apical windows.

Analysis of the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and other parameters related to right heart function in detecting acute radiation-induced right heart injury.

The aim of the present study was to investigate the value of parameters related to right heart function combined with N-terminal pro-B-type natriuretic peptide (NT-proBNP) in acute radiation-induced right heart injury. Seventy patients who received chest radiotherapy (RT) in the RT department of our hospital between September 2015 and March 2019 were included in the study. Of the included 70 patients, 19, 32, 4, and 15 had thoracic esophageal cancer, central lung cancer, thymoma, and left breast cancer, respectively. The Tei index, tricuspid annular displacement, right ventricular ejection fraction, and NT-proBNP of the 70 patients were measured 1 week before RT, at weeks 2 and 4 during RT, and 4 weeks after RT. Differences in the Tei index, the tricuspid annular displacement, and NT-proBNP were significant (P<0.01, P<0.05, and P<0.05, respectively). The Tei index significantly increased in the second week of RT. Tricuspid annular displacement decreased significantly 4 weeks after RT. NT-proBNP reached its peak value in the fourth week of RT. However, there was no significant difference in right ventricular ejection fraction (P>0.05). The Tei index of the right ventricle can be used as a sensitive indicator for the early detection of right heart injury after RT for thoracic tumors. Additionally, tricuspid annular displacement can be used as an index for the early detection of right ventricular damage after RT for thoracic tumors. However, right ventricular ejection fraction showed no significant change in the early stage of right heart damage after RT. Finally, it is important to consider NT-proBNP for the detection of acute radiation-induced heart injury. In acute radiation-induced right heart injury, the combined application of right ventricular Tei index, tricuspid annular displacement, and NT-proBNP is clinically relevant.

Right Ventricular Function and Region-Specific Adaptation in Athletes Engaged in High-Dynamic Sports: A Meta-Analysis.

Structural remodeling of the right ventricle (RV) is widely documented in athletes. However, functional adaptation, including RV pressure generation and systolic free-wall longitudinal mechanics, remains equivocal. This meta-analysis compared RV pressure and function in athletes and controls. A systematic review of online databases was conducted up to June 4, 2020. Meta-analyses were performed on RV systolic pressures, at rest and during exercise, tricuspid annular plane systolic displacement, myocardial velocity (S'), and global and regional longitudinal strain. Bias was assessed using Egger regression for asymmetry. Data were analyzed using random-effects models with weighted mean difference and 95% CI. Fifty-three studies were eligible for inclusion. RV systolic pressure was obtained from 21 studies at rest (n=1043:1651; controls:athletes) and 8 studies during exercise (n=240:495) and was significantly greater in athletes at rest (weighted mean difference, 2.9 mmHg [CI, 1.3-4.5 mmHg]; P=0.0005) and during exercise (11.0 [6.5-15.6 mm Hg]; P<0.0001) versus controls. Resting tricuspid annular plane systolic displacement (P<0.0001) and S' (P=0.001) were greater in athletes. In contrast, athletes had similar RV free-wall longitudinal strain (17 studies; n=450:605), compared with controls but showed greater longitudinal apical strain (16 studies; n=455:669; 0.9%, 0.1%-1.8%; P=0.03) and lower basal strain (-2.5% [-1.4 to -3.5%]; P<0.0001). Functional RV adaptation, characterized by increased tricuspid annular displacement and velocity and a greater base-to-apex strain gradient, is a normal feature of the athlete's heart, together with a slightly elevated RV systolic pressure. These findings contribute to our understanding of RV in athletes and highlight the importance of considering RV function in combination with structure in the clinical interpretation of the athlete's heart.

Noninvasive Assessment of Right Ventricle Function and Pulmonary Artery Pressure Using Transthoracic Echocardiography in Women With Pre-Eclampsia: An Exploratory Study.

Background and objectivePre-eclampsia (PEC) is associated with the release of anti-angiogenic factors that are incriminated in raising systemic and pulmonary vascular resistance (PVR). Compared to the left heart and systemic circulation, much less attention has been paid to the right heart and pulmonary circulation in patients with PEC. We used transthoracic echocardiography (TTE) to estimate pulmonary artery (PA) pressure and right ventricular (RV) function in women with PEC.Materials and methodsWe conducted a case-control study at a tertiary care academic center. Ten early PEC (<34-week gestation) and nine late PEC (≥34-week gestation) patients with 11 early and 10 late gestational age-matched controls were enrolled. Two-dimensional TTE was performed on all patients. The estimated mean PA pressure (eMPAP) was calculated based on PA acceleration time (PAAT). PVR was estimated from eMPAP and RV cardiac output (RV CO). RV myocardial performance index (RV MPI), tricuspid annular plane systolic excursion (TAPSE), tissue tricuspid annular displacement (TTAD), and lateral tricuspid annular tissue peak systolic velocity (S’) were measured.ResultsCompared to early controls, in early PEC, the eMPAP and estimated PVR (ePVR) were elevated, PAAT was reduced, RV MPI was increased, TTAD was reduced, and TAPSE and TV S’ were unchanged. Compared to late controls, in late PEC, the eMPAP and ePVR were elevated, PAAT was reduced, and RV MPI was increased, while TAPSE, TTAD, and TV S’ were unchanged.ConclusionsIn a sample of women with PEC, early PEC was found to be associated with increased eMPAP and ePVR and subclinical decrement of RV function as assessed by TTE. TTE may be a useful noninvasive screening tool for early detection of pulmonary hypertension and RV dysfunction in PEC. An adequately powered longitudinal study is needed to determine the implications of these findings on long-term outcomes.

Comparison of Quantitative Versus Qualitative Assessment of Single Right Ventricular Function for the Prediction of Midterm Outcomes

Multiple studies have shown that quantitative evaluation of right ventricular (RV) systolic function in children with hypoplastic left heart syndrome (HLHS) is associated with outcomes. However, the most widely used method is qualitative, or subjective echocardiographic evaluation. Tricuspid annular displacement (TMAD) is a quantitative method and has been shown to be associated with transplant/death in a cohort of pediatric patients with HLHS. In this study, the same echocardiograms used in the quantitative TMAD study were qualitatively evaluated to see if the assessment correlated with midterm outcomes. We hypothesized that TMAD measures would outperform qualitative measurements. A previously published retrospective study of patients with systemic right ventricle demonstrated that TMAD measurements of function prior to the Glenn procedure were associated with midterm mortality/transplant (mean TMAD 12.4% for survivors and 10.0% for non-survivors/transplant, p = 0.03). Echocardiographic images used in that study were re-evaluated using qualitative assessment of function. A score between severely depressed (0) and supra-normal (7) was assigned independently by three cardiologists. A chart review included short-term clinical outcome measures in addition to midterm mortality/transplant. Spearman correlations and logistic regression were used to estimate the associations between function scores and clinical outcomes. Function scores were measured with acceptable inter- and intra-rater reliabilities in 47 patients who had echocardiograms used in the prior analysis before their bidirectional Glenn. The mean functional score was 5.3 ± 1.32 in survivors and 5.0 ± 1.02 in non-survivors/transplant. Subjective echocardiographic scores of function were not predictive of mortality (p = 0.23). Scores were correlated with length of cardiac intensive care unit stay (Spearman's rho = - 0.31, p = 0.04), but not post-Glenn total length of hospital stay (p = 0.4). A sub-analysis was performed for each individual operator. Only one of three operators produced scores with a significant association with mortality/transplant (p = 0.01, p = 0.25, p = 0.22, respectively). Averaged subjective measurement of function by three pediatric cardiologists in children with single right ventricle prior to the Glenn procedure was not associated with midterm outcomes. Previous work based on the same echocardiograms showed that quantitative analysis was associated with midterm outcomes. This suggests quantitative analysis may be more useful in prognostication. Future studies could confirm these results and identify which quantitative methods are most helpful.

Right Ventricular Systolic Assessment by Transesophageal Versus Transthoracic Echocardiography: Displacement, Velocity, and Myocardial Deformation

First, to compare tricuspid annular displacement and velocity in transthoracic and transesophageal echocardiography (TTE, TEE) using conventional angle-dependent technologies. Second, to evaluate both alternative TEE views as well as an alternative technology (speckle tracking) for overcoming proposed differences in TTE and TEE. Prospective, comparative, cross-over study with a randomized order of image acquisition. University hospital. Adults undergoing cardiac surgery. Postinduction standardized image acquisition and analysis in TTE and TEE by 2 echocardiographers. The authors measured tricuspid annular plane systolic excursion (TAPSE) by M-mode and velocity by tissue Doppler (S') in the apical 4-chamber TTE view and midesophageal 4-chamber TEE view (AP4C, ME4C). They then examined (1) the same measurements in alternative TEE views with proposed better ultrasound angulation; and (2) speckle tracking-based endpoints (TAPSE by speckle tracking, strain, and strain rate). Data were available in 24 of 25 patients. Conventional TAPSE by M-mode and velocity by tissue Doppler (TDI) were underestimated in the ME4C compared with the AP4C reference (mean ± standard deviation: TAPSE: 13.1 ± 3.8 mm v 17.3 ± 4.0 mm; S': 6.7 ± 2.1 cm/s v 9.1 ± 2.2 cm/s; both p < 0.001). Neither a modified deep transgastric view (TAPSE 14.5 ± 4.7 mm, p = 0.017; S' 6.8 ± 1.8 cm/s, p < 0.001) nor a transgastric right ventricular inflow view (TAPSE 12.3 ± 4.0 mm, p = 0.001; S' 6.0 ± 1.3 cm/s, p < 0.001) was similar to the AP4C. Speckle tracking TAPSE was unbiased but with high variability (mean bias = -0.3 mm, 95% limits of agreement = -9.1 to 8.4); strain and strain rate were higher in TEE than for TTE (-17.7 ± 3.6 v -12.6 ± 2.1, p < 0.001; -1.0 ± 0.2/s v -0.7 ± 0.1/s, p < 0.001). Right ventricular displacement, velocity, and myocardial deformation measured by TEE versus TTE are different. Neither alternative transesophageal echocardiography views nor speckle tracking-based deformation is promising; TAPSE by speckle tracking is unbiased but imprecise.

P896 Feasibility and accuracy of echocardiographic estimates of tricuspid annular displacement

Abstract Background Tricuspid annular plane systolic excursion (TAPSE) is a validated index of right ventricular function in heart failure. Current guidelines recommend that TAPSE be measured employing M-mode echocardiography (TAPSEM). However, TAPSEM is often overlooked during routine clinical assessment. This study aimed to assess the correlation and strength of agreement between other retrospectively obtainable echocardiographic equivalents of tricuspid annular displacement during systole (TAD) and TAPSEM. Methods An echocardiographic review was performed in consecutive subjects in sinus rhythm referred for the assessment of dyspnoea or heart failure. TAD was measured employing 2D (TAD2D), tissue velocity imaging (TADTVI), and speckle tracking echocardiography (TADSTE) and compared with TAPSEM as reference. Results 100 subjects were analysed (age: 61± 14; 49% Female) All methods demonstrated good feasibility. Of all the evaluated methods, TAD2D demonstrated the strongest association with TAPSEM with minimal bias and reasonable limits of agreement (Table 1). Bias between methods was further reduced in subjects with significant pulmonary hypertension (RVSP &amp;gt; 50mmHg (35%); Bland-Altman mean ± SD = 0.09 ± 2.0 mm). A good agreement between TADSTE and TAPSEM was as well observed. In contrast, TADTVI yielded an underestimation of TAPSEM. Conclusions TAD2D and TADSTE provide feasible and accurate alternatives to TAPSEM and maybe useful during retrospective analysis of RV longitudinal function. Feasibility, Correlation &amp; B-A Analysis TAD Methods Feasibility R value P Value Bland-Altman mean difference ± SD TAD2D 92% 0.94 &amp;lt;0.001 0.22 ± 1.87 mm TADTVI 88% 0.86 &amp;lt;0.001 1.59 ± 3.1 mm TADSTE 85% 0.87 &amp;lt;0.001 0.47 ± 2.7 mm TAD, Tricuspid annular displacement; 2D, Two dimensional; TVI, tissue velocity imaging; STE, speckle tracking echocardiography

Feasibility and accuracy of tricuspid annular displacement assessed by speckle tracking echocardiography and Doppler tissue imaging.

Tricuspid annular plane systolic excursion (TAPSE) is a recommended quantitative measure of right ventricular (RV) longitudinal function assessed by M-mode echocardiography. Offline alternatives are desirable when TAPSE is unavailable. This study aimed to assess the feasibility, reliability, and agreement between retrospectively obtained measures of tricuspid annular displacement using Doppler tissue imaging (TADDTI ) and speckle tracking echocardiography (TADSTE ) compared with reference TAPSE. Consecutive subjects referred for evaluation of heart failure were enrolled. Subjects in atrial fibrillation, significant valvular disease, or with poor image quality were excluded. TAPSE was measured during the examination using M-mode. TADSTE was measured as the maximal longitudinal displacement of the RV basal segment in systole using speckle strain imaging. TADDTI was derived offline from color-DTI superimposed grayscale images. 107 subjects (age 60±16; 48% female) were analyzed. Both TADDTI and TADSTE demonstrated good feasibility and excellent intra- and inter-observer concordances. Although both measures demonstrated strong association with TAPSE, TADDTI showcased lower specificity to identify RV dysfunction and higher false positives. Bland-Altman analysis revealed a tendency of TADDTI to underestimate TAPSE (bias=1.40; SD=2.74mm) as compared with TADSTE (bias=0.27; SD=2.30mm). Wide limits of agreement were observed for both methods. TADSTE and TADDTI provide reproducible and feasible quantification of RV function. However, TADDTI significantly underestimates TAPSE limiting the interchangeability of these modalities.

Value of tissue-tracking tricuspid annular plane by speckle-tracking echocardiography for the assessment of right ventricular systolic dysfunction.

Assessment of right ventricular (RV) function remains challenging because of its complex geometry. Application of speckle-tracking echocardiography (STE) to the tricuspid annulus provides rapid and automated assessment of the midpoint of the tricuspid annular plane displacement (TAD). The aim of this study was to investigate the value of tissue-tracking TAD for the assessment of RV systolic dysfunction. We retrospectively studied 61 patients in whom RV ejection fraction (EF) measured by 3-dimensional echocardiography was performed. STE-derived displacement of the midpoint between the septal and lateral tricuspid annulus and its percentage of RV length at end-diastole (MTAD) were automatically assessed. We performed comparative analyses between the RVEF ≥45% group and the RVEF <45% group in each parameter for the assessment of RV systolic function. MTAD was successfully assessed in 56 (91.2%). According to receiver operating characteristics analysis, RVEF <45% was best detected by MTAD <14.7% with area under curve (AUC) 0.97, sensitivity 93%, specificity 95%, followed by RV free wall longitudinal strain (AUC 0.86), RV fractional area change (AUC 0.84), tricuspid annular plane systolic excursion (AUC 0.79), and systolic peak velocity of tricuspid annulus (AUC 0.70), although there was no significant difference between MTAD and RV free wall strain (P=0.14). The present study showed that MTAD was simple index and useful for the assessment of RV systolic dysfunction.

Tricuspid annular displacement measured by 2-dimensional speckle tracking echocardiography for predicting right ventricular function in pulmonary hypertension: A new approach to evaluating right ventricle dysfunction.

This study aimed to determine the ability of tricuspid annular displacement measured by 2-dimensional speckle tracking echocardiography (STE) to predict right ventricular (RV) dysfunction in pulmonary hypertension (PH) patients. Here, we present a new method for assessing RV function that also employs STE and is based on measurement of tricuspid annular displacement.A total of 225 patients were divided into 2 groups according to the pulmonary artery systolic blood pressure (PASP), estimated by echocardiographic measurement of tricuspid regurgitation: group I (PASP ≥50 mm Hg) and group II (36 mm Hg ≤ PASP <50 mm Hg). The tricuspid annular plane systolic excursion (TAPSE), RV index of myocardial performance (RIMP), RV fractional area change (RVFAC), tissue Doppler-derived tricuspid lateral annular systolic velocity (s'), and the tricuspid annular longitudinal displacement (TMAD) parameters were measured. Thirty patients underwent cardiac magnetic resonance (CMR) examination, and right ventricular ejection fraction (RVEF) was calculated.The conventional parameters as well as the TMAD parameters differed significantly between the 2 groups (all P < .01). Good correlation was observed between the TMAD parameters and CMR-derived RVEF (all P < .01). The TMAD parameters had moderate predictive value for predicting RV dysfunction in PH patients (all P < .01). From receiver operating characteristic curves, we determined the optimal cut-off values for TMAD parameters for detecting RV dysfunction with good sensitivity and specificity.The TMAD parameters can predict the decline of RV function in patients with PH and thus provide new diagnostic indices for clinical management of these patients.

Differential effect of assisted reproductive technology and small‐for‐gestational age on fetal cardiac remodeling

Fetuses conceived by assisted reproductive technology (ART) and those that are small-for-gestational age (SGA) show cardiovascular remodeling in utero; however, these two conditions are often associated. We aimed to evaluate the differential effect of ART and SGA on fetal cardiac remodeling. This was a prospective cohort study of term singleton pregnancies seen at our department between April 2011 and September 2013. The cohort was divided according to fetal growth and mode of conception into the following four groups: 102 appropriate-for-gestational-age (AGA) fetuses conceived spontaneously (controls), 72 AGA fetuses conceived by ART (ART-AGA), 31 SGA fetuses conceived by ART (ART-SGA) and 28 SGA fetuses conceived naturally (Spont-SGA). SGA was defined as birth weight < 10th centile. Fetal echocardiography was performed at 28-32 weeks to assess cardiac dimensions, geometry and function. ART fetuses had dilated atria (mean left atrium-to-heart area ratio: controls, 15 ± 2.7%; ART-AGA, 18 ± 4.1%; Spont-SGA, 14 ± 3.7%) and more globular ventricles (left ventricular sphericity index: controls, 1.77 ± 0.2; ART-AGA, 1.68 ± 0.2; Spont-SGA, 1.72 ± 0.2), with normally sized hearts. In contrast, SGA fetuses had enlarged hearts (cardiothoracic ratio: controls, 24 ± 3%; ART-AGA, 24 ± 4%; Spont-SGA, 29 ± 6%), preserved atrial size, more globular and concentric hypertrophic ventricles (left ventricle relative wall thickness: controls, 0.48 ± 0.17; ART-AGA, 0.54 ± 0.13; Spont-SGA, 0.63 ± 0.23). Both ART and SGA fetuses had decreased longitudinal motion (tricuspid annular ring displacement: controls, 6.5 ± 0.8 mm; ART-AGA, 5.5 ± 0.7 mm; Spont-SGA, 5.9 ± 0.6 mm) and impaired relaxation (left isovolumetric relaxation time: controls, 47.0 ± 7.3 ms; ART-AGA, 50.0 ± 7.9 ms; Spont-SGA, 49.5 ± 9.3 ms). ART-SGA fetuses presented a combination of features from both ART and SGA groups. SGA and conception with ART were associated with distinct patterns of fetal cardiac remodeling, supporting the concept that they are independent causes of cardiac programming. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Poster Session 3The imaging examination and quality assessmentP626Value of mitral and tricuspid annular displacement to assess the interventricular systolic relationship in severe aortic valve stenosis : a Pilot studyP627Follow-up echocardiography in asymptomatic valve disease: assessing the potential economic impact of the European and American guidelines in a dedicated valve clinic, compared to standard care.P628The tricuspid valve: identification of optimal view

Poster Session 3The imaging examination and quality assessmentP626Value of mitral and tricuspid annular displacement to assess the interventricular systolic relationship in severe aortic valve stenosis : a Pilot studyP627Follow-up echocardiography in asymptomatic valve disease: assessing the potential economic impact of the European and American guidelines in a dedicated valve clinic, compared to standard care.P628The tricuspid valve: identification of optimal view

A clinical study on tricuspid annular displacement predicting the right ventricular function of pulmonary hypertension measured by two-dimensional speckle tracking echocardiography

Objective To measure tricuspid annular displacement by two-dimensional speckle tracking echocardiography in pulmonary hypertension (PH) patients, and compare with the right ventricular function parameters, finally discuss the clinical application value of this technology in evaluating the right ventricular function in PH. Methods A total of 58 patients diagnosed or suspected diagnosed as PH were divided into PH group and control group according to pulmonary arterial systolic pressure measured by echocardiography. The right ventricular function parameters included: tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (FAC), tissue Doppler-derived tricuspid lateral annular systolic velocity (s') and right ventricular index of myocardial performance (RIMP). The parameters of tricuspid annular displacement included: the peak systolic tricuspid annular displacement at right ventricular free wall (TMAD1), the peak systolic tricuspid annular displacement at interventricular septum (TMAD2), the peak systolic tricuspid annular displacement at midpoint of tricuspid annulus (TMADm) and the right ventricular longitudinal shortening (TMADm%). Results ① There were significant statistical differences between two groups in TAPSE, RIMP, FAC and s' (P 0.54 and s'<9.5 cm/s, their sensitivities were 81.8%, 84.4%, 85.7% and 72.3% respectively, and their specificities were 72.0%, 73.1%, 70.3% and 100% respectively. Conclusions The tricuspid annular tissue displacement parameters can predict the decrease of right ventricular function in patients with PH, and provide a new diagnostic index for clinical treatment and prognosis. Key words: Echocardiography; Pulmonary hypertension; Tissue motion annular displacement; Ventricular function, right; Speckle tracking imaging

Value of annular plane systolic excursion difference in evaluation of heart systolic function of normal fetuses in the second and late trimester with echocardiography

Objective To obtain the annular plane systolic excursion difference (APSED) of fetuses in second and late trimester by free angle M-mode(FAM) and tissue motion of annular displacement(TMAD) in order to assess the fetal ventricular function. Methods The mitral annular plane systolic excursion(MAPSE) and tricuspid annular plane systolic excursion(TAPSE) of four hundred and fifty five normal fetuses from 20 to 41 weeks were measured by FAM echocardiography, and the difference between them were calculated. Early diastolic velocities (Em) of the mitral annular and early diastolic velocities (Em') of the tricuspid annular were estimated by pulsed-wave tissue Doppler imaging(TDI), meanwhile systolic velocities (Sm) of the mitral annular and systolic velocities (Sm') of the tricuspid annular were also estimated by TDI. Fifty normal fetuses in the second and late trimester were choosed randomly, two-dimension imaging was obtained at the apical four-chamber view, then mitral annular plane and tricuspid annular plane displacement curve were acquired at the same time by using off-line QLab 8.1 software, and the differences in the peak time between them were compared. The trace of annular displacement were recorded by color tissue tracking technology. Results There was a significant difference between FAM-TAPSE and FAM-MAPSE in different gestational weeks (P 0.05). Conclusions The APSED existed in the second and late trimester continually. It was considering associated with fetal ventricular torsion. As the growth of gestational weeks, the increase of APSED reflected the enhanced reserve capacity of the fetal ventricular torsion. APSED can reflect the longitudinal motion and torsion movement of fetal ventricle quantitatively, and can be used as a new index to assess the fetal cardiac function. Key words: Echocardiography; Fetal heart; Ventricular function; Tissue motion of annular displacement; Annular plane systolic excursion difference