Tricuspid Annular Plane Systolic Excursion Measurements Research Articles

Correlation of Tricuspid Annular Plane Systolic Excursion (TAPSE), as a predictor of Right Ventricular Systolic Function with Left Ventricular Systolic Function

Introduction: Right Ventricular (RV) function is a strong predictor of outcome in many Cardiovascular Diseases, but its significance is often neglected. Right Ventricle (RV) dysfunction may be secondary to Left Ventricle (LV) dysfunction as a consequence of “Ventricular Interdependence. Tricuspid Annular Plane Systolic Excursion (TAPSE) is an Echocardiographic measure that allows us to assess Right Ventricular systolic function and it correlates well with reference techniques like Cardiac Magnetic Resonance Imaging. Echocardiographic recording of the Tricuspid Annular Plane Systolic Excursion (TAPSE) has been recommended for assessing Right Ventricular function in cardiac patients. As RV dysfunction is associated with high in-hospital morbidity and mortality, early reorganization of RV dysfunction is warranted in patients with or without LV dysfunction. Objective: Our objective was to demonstrate the relationship of TAPSE, as a predictor of RV Systolic Function with Left Ventricular Systolic Function. Method: This was a cross –sectional study in patients undergoing comprehensive Transthoracic Echocardiography for any indication. From April 2022 to March 2023 we prospectively enrolled 100 adult (from 30 to age 103years) of both sexes who presented to the Cardiology Clinic of LABAID Cardiac Hospital. We performed a complete Transthoracic Echocardiography study. Assessed LV systolic function by conventional method. We additionally measured TAPSE in 2-dimensional M-mode Echocardiograms from the apical 4- chamber view, positioning the cursor on the lateral Tricuspid Annulus near the free RV wall and aligning it as close as possible to the apex of the heart. The mean values were taken by at least 2 measurements for reducing inter-observer and intra-observer variability’s. Values of TAPSE as a predictor of RV Systolic Function were correlated with Left Ventricular Systolic Function. Patients with confirmed congenital & Valvular heart disease were excluded. Results: Mean TAPSE values were (19.15±3.87mm) irrespective of LVEF, with no significant differences between sexes, (18.45±3.801 mm) in male , (19.94±3.853 mm) in female (P=.056). TAPSE value was (22.00±1.581 mm) in person with normal LVEF & (16.77±2.455 mm) in person with reduced LVEF (P<.001). A statistically significant positive correlation of LVEF (r=.813) and significant negative correlation of EPSS (r=-.639) were observed with TAPSE (p<0.001). But no significant correlation of TAPSE was found between age (r=-.185), gender (r=.192) & RVIDd (r= -.063) (p >0.05). Multivariate analysis confirmed these correlations and the interactions between variables. Graph of estimated population-based TAPSE values adjusted by LV function was provided. Conclusion: We determined the values of TAPSE in patients with or without LV systolic dysfunction and assessed relationship of these values with LVEF. TAPSE is predictive of RV Systolic function & correlated significantly with LV systolic function. The TAPSE measurement is simple & reproducible. This observation could guide decision making in daily clinical practice. Bangladesh Crit Care J March 2024; 12 (1): 11-17

Determination of Values of the Tricuspid Annular Plane Systolic Excursion (TAPSE) In Bangladeshi Adult Patient With or Without LV Dysfunction

Background: Tricuspid annular plane systolic excursion (TAPSE) is an Echocardiographic measure that allows us to assess right ventricular systolic function and it correlates well with reference techniques like Cardiac Magnetic Resonance Imaging. TAPSE measurement is common in adults. Objective: Our objective was to determine values of TAPSE in Bangladeshi adults with or without LV systolic dysfunction and to determine the relationship of these values with age, sex, RVIDd, LVEF & EPSS. Method: This was an prospective observational study in patients undergoing comprehensive transthoracic echocardiography for any indication. From April 2022 to April 2023 we prospectively enrolled 100 adult (from 30 to age 80 years) of both sexes who presented to the Cardiology Clinic of LABAID Cardiac Hospital. We performed a complete transthoracic echocardiography study. We measured TAPSE in 2-dimensional M-mode echocardiograms from the apical 4- chamber view, positioning the cursor on the lateral tricuspid annulus near the free RV wall and aligning it as close as possible to the apex of the heart . The mean values were taken by at least 2 measurements for reducing interobserver and intraobserver variability’s. Patients with confirmed congenital & valvular heart disease were excluded. Results: Mean TAPSE values were 19.15±3.87cm irrespective of LVEF, with no significant differences between sexes, 18.45±3.801 in male , 19.94±3.853 in female (P=.056). TAPSE value was 22.00±1.581 in person with normal LVEF & 16.77±2.455 in person with reduced LVEF ( P<.001) A statistically significant positive correlation of LVEF (r=.813) and significant negative correlation of EPSS (r=-.639) were observed with TAPSE (p<0.001). But no significant correlation of TAPSE was found between age (r=-.185)). ), gender (r=.192) & RVIDd (r= -.063) (p >0.05). Multivariate analysis confirmed these correlations and the interactions between variables (LVEF & EPSS). Graphs of estimated population-based TAPSE values adjusted by age and LV function are provided. Conclusion: We determined values of TAPSE in Bangladeshi adult population with or without LV systolic dysfunction and assessed relationship of these values with age, sex, RVIDd, LVEF & EPSS. The TAPSE measurement was reproducible and associated directly with LV systolic function. These reference values could guide decision making in daily clinical practice. Bangladesh Heart Journal 2023; 38(2): 92-101

Outcome of Patients With Cardiogenic Shock and Previous Right Ventricular Impairment Represented by Decreased Tricuspid Annular Plane Systolic Excursion and Tricuspid Annular Plane Systolic Excursion to Pulmonary Artery Systolic Pressure Ratio

This study investigates the prognostic impact of known decreased ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) and TAPSE in patients with cardiogenic shock (CS). In patients with pulmonary artery hypertension and in critically ill patients, decreased TAPSE and TAPSE/PASP ratio are known to be negative predictors. However, studies regarding the prognostic impact in patients with CS are limited. Consecutive patients with CS from June 2019 to May 2021 treated at a single center were included. Medical history including echocardiographic parameters such as TAPSE and PASP was documented for each patient. The primary endpoint was all-cause mortality at 30 days. Statistical analyses included univariable ttest, Spearman's correlation, C-statistics, Kaplan-Meier analyses, and Cox proportional regression analyses. A total of 90 patients with CS and measurement of TAPSE and TAPSE/PASP ratio were included. TAPSE and TAPSE/PASP ratio measured several months before intensive care unit admission were both able to predict 30-day survival in CS patients, and were both lower in 30-day nonsurvivors. TAPSE/PASP ratio <0.4mm/mmHg (log-rank p=0.006) and TAPSE <18mm (log-rank p=0.004) were associated with increased risk of 30-day all-cause mortality. After multivariable adjustment, TAPSE/PASP ratio <0.4mm/mmHg was not able to predict 30-day all-cause mortality, whereas TAPSE <18mm was still significantly associated with the primary endpoint (hazard ratio 2.336, confidence interval 1.067 to 5.115, p=0.034). In consecutive patients presenting with CS, compared to TAPSE alone, previously determined TAPSE/PASP ratio did not improve risk prediction for 30-day all-cause mortality.

Which Type of Cardiomyopathy (Ischemic or Dilated) can be Attributed to more Alteration in Right Ventricular Dysfunction?

Background: There are few studies in the literature comparing the RV function of the two entities of dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM). The aim of this study was to compare RV dysfunction among patients with ICM or DCM. Methods: The study population consisted of 287 consecutive patients with heart failure referred for pre-CRT echocardiography evaluation at the Tehran Heart Center between January 2005 and December 2010. A complete transthoracic echocardiographic examination, which included 2-dimensional and Doppler echocardiography with color flow mapping were performed using standard techniques. For assessing RV function, the two parameters of the tricuspid annular plane systolic excursion (TAPSE) and right ventricular peak mean systolic tissue velocity (RVSM) were measured. Results: Comparing RV function on TAPSE measurement between the ischemic and dilated cardiomyopathy groups showed no significant differences between them that the mean of TAPSE was 15.05 ± 4.65 mm and 15.64 ± 4.90 mm, respectively. With respect to assessing RV function using peak mean systolic RVSM measurement, this parameter in the ischemic and dilated cardiomyopathy were also similar (3.795 ± 2.050 cm/s versus 4.551 ± 2.753 cm/s, p = 0.176). Conclusion: There is no difference with regard to RV functional state between ICM and DCM.

Impact of serial measurements of tricuspid annular plane systolic excursion on mortality and morbidity after heart transplantation.

The impact of right ventricular (RV) dysfunction on long-term post-HTx outcomes remains uncertain. We assessed the impact of serial measurements of Tricuspid Annular Plane Systolic Excursion (TAPSE) on post-HTx mortality and morbidity. This two-center retrospective cohort study included consecutive adult HTx recipients (2000-2017). We used multivariable extended hazard regression models to evaluate the association between TAPSE and left ventricular ejection fraction (LVEF), entered as time-dependent variables, and all-cause mortality, cardiac allograft vasculopathy (CAV), acute cellular rejection (ACR), and chronic kidney disease (CKD). TAPSE was modelled using cubic splines. We included 485 HTx recipients (9461 TAPSE measurements), median (25th- 75th percentile) 19 (10-27) mm; median age was 52 (41-59) years, and 71.3% were male. During a follow-up of 6.7 (3.0-10.8) years, 92 patients died, 225 had ACR >2R, 234 CAV, and 91 CKD. By multivariable analysis, for each 1-mm decrease in patients with a TAPSE value <15mm, mortality increased by 22% (P<.001). For the average HTx recipient with a TAPSE of 15mm, 10mm, and 6mm, 1-year mortality was 3%, 7%, and 17%, and 5-year mortality was 8%, 20%, and 43%, respectively. Reduced TAPSE was significantly associated with increased CAV but notACR and CKD. A decrease in TAPSE below 15mm represents clinically significant graft dysfunction, warranting close monitoring.

The role of tricuspite annular plane systolic excursion as a marker of hypovolemia in healthy blood donor volunteers.

The aim of this study is to compare the diameter of the inferior vena cava with tricuspid annular plane systolic excursion (TAPSE) measurement in order to determine the volume loss before and after blood donation in healthy volunteers. This Institutional Review Board-approved single center, prospective, cross-sectional study included 60 healthy blood donors donating in a tertiary care hospital's blood bank. After obtaining written consent, systolic, diastolic, and mean arterial blood pressures along with pulse rate of the donors were measured in sitting and supine positions by the attending physician, then, inferior vena cava (IVC) and TAPSE measurements were made before and after blood donation. Statistically significant differences was found between standing systolic blood pressure and pulse rate, lying systolic blood pressure and pulse rate, IVC and TAPSE values before and after blood donation (p<0.05). There was no difference between the other variables before and after blood donation. Our study revealed that, low IVC and TAPSE values correlated in determining blood loss after blood donation. TAPSE may be useful to predict blood loss in early stages of hypovolemic shock.

The application experience of focused ultrasound heart examination in patients with COVID-19 in Prone-position

Aim of the study. To study the experience of using focused transthoracic echocardiography in patients with COVID-19 in prone position (fEchoPr) in intensive care units (ICU).Materials and methods. The retrospective observational study included 53 patients (period from 15 April to 31 December 2020). Inclusion criteria: confirmed diagnosis of COVID-19, availability of fEchoPr data, outcome certainty (discharge/death). We analyzed electronic medical records. The fEchoPr was performed in patients in the prone position with a bolster under the left side of the chest and left arm raised (‘swimmer’s position’). We assessed the systolic function of the right ventricle (RV) (tricuspid annular plane systolic excursion (TAPSE)), RV size, RV/LV ratio, systolic function of the left ventricle (LV) (left ventricular outflow tract velocity time integral. (LVOT VTI)), and pulmonary hypertension (PH) (tricuspid regurgitation peak gradient (PGTR). Depending on the results, the patients were divided into 2 groups: informative (+fEchoPr) and non-informative (–fEchoPr) examinations.Results. There was no statistically significant difference in the groups (+fEcho n = 35 vs –fEcho n = 18) by age (65.6 ± 15.3 vs 60.2 ± 15.8, p &gt; 0.05), by gender (male: 23 (65.7%) vs 14 (77.8%), p &gt; 0.05), by body mass index (31.3 ± 5.3 kg/m 2 vs 29.5 ± 5.4 kg/m2 , p &gt; 0.05), by mechanical ventilation support (24 (68.6%) vs 17 (94.4%), p = 0.074), by NEWS scale indicators (6.9 ± 3.7 vs 8.5 ± 3.5 points), by mortality (82.8% vs 94.4%, p &gt; 0.05). Correlation analysis revealed a moderate inverse relationship between being on mechanical ventilation and the informative value of the study (Spearman's r = −0.30 at p = 0.033). In the +fEchoPr group, the correct measurement of TAPSE and RV/LV was carried out in 100%: a decrease in RV systolic function was recorded in 5 patients (14%), expansion of the RV in 13 patients (37%). Signs of PH were detected in 11 patients (31%), PGTR could not be measured in 10 patients (28%). LV systolic dysfunction was detected in 7 patients (20%). No pathology was detected in 16 patients (46%). One patient was diagnosed with infective endocarditis of native mitral valve, which was later confirmed by autopsy.Conclusion. In 66% of cases, fEchoPr examinations were informative, especially in terms of assessing the state of the right heart. fEchoPr examination is an affordable, valid and reproducible method to assess and monitor the state of the heart in ICU patients.

Tricuspid Annular Plane Systolic Excursion as a Potential Marker of Hospital Utilization in Patients with Sickle Cell Disease

Objective: Pulmonary Artery Hypertension (PAH) is an independent risk factor for increased morbidity in Sickle Cell Disease (SCD) patients. Tricuspid Annular Plane Systolic Excursion (TAPSE) can be used as a surrogate measure for PAH. The objective of this study was to determine whether lower TAPSE values are associated with increased Emergency Department (ED) and hospital utilization. Methods: TAPSE measurements were retrospectively obtained from bedside echocardiograms from a convenience sample of 28 SCD patients presenting to the ED with SCD pain. TAPSE was considered abnormal if &lt;24.9mm, one standard deviation below the mean TAPSE for SCD patients. Medical records were reviewed to determine ED visits and hospital overnight stays over a two-year period. A t-test analysis and Pearson’s correlation were used for each variable. Results: The initial sample included 28 SCD patient encounters. TAPSE measurements were abnormal in 5 patients and normal in 23 patients. The mean number of ED visits/year for the abnormal and normal TAPSE group were 23.00 and 16.87, respectively (p=0.57) with moderate negative linearity (p=0.03). The mean number of hospitalized days for abnormal and normal TAPSE groups was 108.8 and 59.6, respectively (p=0.10) with moderate negative linearity (p=0.07). Conclusion: Lower TAPSE values (&lt;24.9mm) in SCD patients were associated with higher ED and hospital utilization. If findings are replicated in larger studies, TAPSE may serve as a marker of morbidity in SCD patients presenting to the ED.

Abstract 15571: Echocardiographic Characteristics and Their Association With Outcome in Hospitalized Covid-19 Patients With Cardiovascular Disease

Background: Echocardiographic characteristics and the prognostic value of echocardiographic parameters in COVID-19 patients with cardiovascular disease (CVD) remain unclear. Objectives: We aimedto describe and compare echocardiographic characteristics of hospitalized COVID-19 patients with and without CVD, and explore the prognostic value of echocardiographic parameters in COVID-19 patients with CVD. Methods: 157 consecutive hospitalized COVID-19 patients were enrolled in our study. Left ventricular (LV) and right ventricular (RV) structure and function were assessed using bedside echocardiography. Results: 89 (56.7 %) patients had underlying CVD.Compared with patients without CVD, those with CVD were more likely to havehigher levels of high-sensitivity troponin I (hs-TNI) and B-type natriuretic peptide, and higher incidence of ARDS, acute heart injury and deep vein thrombosis. During hospitalization, 23(14.6%) patients died. Mortality was significantly higher in CVD compared with non-CVD patients (22.5% vs. 4.4%, p =0.002). CVD patients had increased mitral E/e’, lower tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RVFAC), and higher pulmonary artery systolic pressure. TAPSE, RVFAC and elevated hs-TNI level were independent predictors of higher mortality.Furthermore, we found the incremental prognostic value of TAPSE over RVFAC and clinical parameters in COVID-19 patients with CVD using a likelihood ratio test, Akaike information criterion and C-index. Conclusions: COVID-19 patients with CVD displayed impaired cardiac function, which is associated with higher mortality. The additional prognostic value of TAPSE over the other clinical and echocardiographic parameters indicate that TAPSE measurement may be important for risk stratification in COVID-19 patients with CVD.

660 Echocardiographic Right Ventricular Assessment in Adult Patients With Repaired Tetralogy of Fallot

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease seen in the New Zealand population. Surgically corrected patients are monitored in adulthood using multimodality imaging. Echocardiography plays an important role in Right Ventricular (RV) function and volume quantification. However, the measurements can be challenging due to image acquisition and quality. We reviewed consecutive patients >15 years old with prior TOF repair who had a transthoracic ECHO between November 2018 and November 2019 in Wellington Hospital. 8 were male and average age was 36 +/-13 years. The recording of standard RV measures was assessed. Measurements included geometric parameters: (chamber diameter, fractional area change (FAC), three-dimensional assessment) and non-geometric indices (tricuspid annular plane systolic excursion (TAPSE), RV Tissue Doppler and RV strain). Sixteen patients fulfilled our criteria and 15 had a qualitative assessment of RV size and function. 11 (69%) were reported as having suboptimal image quality. 9 (56%) had chamber diameter measures, 2 (12.5%) had FAC. No patients had 3D assessment of the right ventricle.10 (63%) had a TAPSE measurement, 5 (33%) had RV TDI S’ wave assessment, and 5 (31%) had RV free wall strain assessment. In our cohort, quantification of RV size and function in post-repair tetralogy of fallot adult patients was infrequently performed, with suboptimal image quality listed as an issue. The results provide an opportunity to improve our RV quantification protocols and re-audit our performance in the future.

A Novel Speckle-Tracking Based Method for Quantifying Tricuspid Annular Velocities in TEE

A novel speckle-tracking-based option for measuring tricuspid annular velocities in the midesophageal 4-chamber view (ME4C) was compared with velocities measured by tissue Doppler in the apical-4 chamber view (AP4C). Because this method was based on a modified speckle-tracking-based measurement of tricuspid annular plane systolic excursion (TAPSE), the authors also compared TAPSE by speckle tracking in the ME4C with TAPSE by M-mode in the AP4C. The authors hypothesized that velocities measured by speckle tracking in transesophageal echocardiography (TEE) would be similar, correlate, and agree with those measured by tissue Doppler in transthoracic echocardiography (TTE). Prospective diagnostic study with randomization of the order of post-induction echocardiography views by TTE (AP4C) and TEE (ME4C). Images were both acquired and analyzed by 2 echocardiographers independently. The primary outcome was S'; secondary outcomes were E', A', and TAPSE. Single university hospital. Consecutive adult patients undergoing cardiac surgery (mainly coronary artery bypass grafting). None. Complete data was available in 24 of 25 patients. For the primary outcome, S' measured by speckle tracking in the ME4C correlated and agreed with S' measured by tissue Doppler in the AP4C (S'STE = 0.87STDI + 0.60, p < 0.001, r = 0.78; mean bias -0.6 cm/s, 95% limits of agreement (LoA) -3.5 to 2.4 cm/s). Similarly results were found for E', but not A' (E'STE = 0.69E'TDI + 2.37, p < 0.001, r = 0.71; mean bias 0.1 cm/s, 95%LoA -2.5 to 2.8cm/s; A'STE = 0.15A'TDI + 11.17, p = 0.629). TAPSE measurements by the authors' modified speckle-tracking-based technique were similar to TAPSE by M-mode (18.2 ± 5.5 mm and 17.1 ± 3.9 mm, respectively). Tricuspid annular velocities (S'STE, E'STE) determined by speckle tracking in TEE seem to be promising surrogates for velocities measured in TTE. This may be important for perioperative assessment of the right ventricle.

Association between Serial Measurements of Tricuspid Annular Plane Systolic Excursion and Mortality Post Heart Transplant

Purpose Graft dysfunction after heart transplantation (HT) is a serious complication and is usually defined based on left ventricular function. Tricuspid Annular Plane Systolic Excursion (TAPSE), an echocardiographic measure of right ventricular (RV) global longitudinal function, has shown discrepancies in its correlation with RV ejection fraction (EF) after HT. Purpose: to evaluate the impact of serial TAPSE measurements (surrogate for RVEF) after HT on mortality. Methods A single-center retrospective cohort study of 249 consecutive adult patients undergoing de novo HT between 2000 and 2014. TAPSE was assessed by serial echocardiography. We used a cubic spline model with 3 knots (11 mm, 14.5 mm, 20 mm) to evaluate the association between serial TAPSE used as a time-dependent variable and all-cause mortality. Results 249 HT patients had 2,574 TAPSE measures (mean 15.5 ± 3.8 TAPSE measurements per HT recipient). Mean age was 48 ± 12 years, and 70% were men, mean ischemic time was 3.7 ± 1.2 hours, with female donor to male recipient sex mismatch in 16%. The median TAPSE value was 15.5 mm (25th and 75th percentile: 13 mm and 18 mm). During a median follow-up of 8.7 years (minimum and maximum: 14 days and 17.5 years), there were 34 deaths due to all-causes. For every 1 mm decrease in TAPSE, we observed a 37% increase in mortality (fig 1. HR 1.37, 95% CI 1.20-1.53, p-value Conclusion RV dysfunction measured by TAPSE was associated with increased post-HT mortality. Any decrease in TAPSE below 15 mm is both statistically and clinically important, raising consideration for monitoring and eventual interventions.

Tricuspid annular plane systolic excursion-to-aortic ratio provides a bodyweight-independent measure of right ventricular systolic function in dogs

ObjectivesTo evaluate whether tricuspid annular plane systolic excursion (TAPSE) can be normalized to aortic valve (Ao) measurements in dogs. To determine TAPSE:Ao reference intervals for healthy dogs and examine diagnostic performance of TAPSE:Ao in dogs with pulmonary hypertension (PH). AnimalsOne hundred and thirty-seven healthy adult dogs; 115 dogs with myxomatous mitral valve disease (MMVD) but no PH; 91 dogs with PH. MethodsA combined prospective and retrospective study. Full echocardiographic evaluations were performed on all dogs; TAPSE was indexed to Ao to produce a unitless TAPSE:Ao. Reference intervals for TAPSE:Ao were generated, and TAPSE:Ao was regressed on tricuspid regurgitant jet velocity in dogs with PH and on LA:Ao in dogs with MMVD without PH. Diagnostic test analysis was used to examine the ability of TAPSE:Ao to identify severe PH. An adjusted TAPSE:Ao (TAPSE:Ao(adj)) was derived to account for MMVD in dogs with PH. ResultsThe ratio, TAPSE:Ao, removed the effect of bodyweight from TAPSE measurements. Healthy dogs had TAPSE:Ao > 0.65. The ratio, TAPSE:Ao, showed a linear negative relationship with tricuspid regurgitation velocity and positive relationship with LA:Ao. The adjusted ratio, TAPSE:Ao(adj), increased the sensitivity of diagnosis of PH in dogs with moderate-severe MMVD without affecting the diagnosis of PH in dogs with PH and with no or mild MMVD. ConclusionsThe ratios, TAPSE:Ao and TAPSE:Ao(adj), are a bodyweight-independent means of assessing right ventricular systolic function in dogs and for identifying severe PH in dogs with or without MMVD.

Echocardiographic assessment of right ventricular contractile reserve in healthy subjects.

Exercise-induced increase in pulmonary artery systolic pressure (PASP) as a possible measure of right ventricular (RV) contractile reserve has been shown to predict survival in severe pulmonary hypertension. However, RV contractile reserve can also be measured by changes in stroke volume (SV), tricuspid annular plane systolic excursion (TAPSE), or tricuspid annular systolic velocity (S'). The limits of normal values and the functional significance of these changes in healthy subjects are not well known. In this prospective study, 90 healthy subjects (45 male, mean age 39 ± 13years) underwent exercise stress echocardiography with measurement of TAPSE, S', TAPSE/PASP, SV, and PASP at rest and peak exercise. Maximum and minimum normal values were reported for all indices. Normal values of exercise-induced changes (Δ) were 4 to 10mm for TAPSE, 6 to 14cm/s for S', 12 to 57mm Hg for PASP, 0 to 96mL for SV, and -1.2 to 0mm/mm Hg for TAPSE/PASP. At peak exercise, women showed lower ΔTAPSE/PASP, ΔPASP, ΔS', and ΔSV, but higher TAPSE/PASP than men. Aging was associated with decreased ΔTAPSE/PASP, ΔTAPSE, ΔS', ΔPASP, and ΔSV. In addition, ΔS', ΔTAPSE/PASP, ΔPASP, and ΔSV, but not ΔTAPSE, were directly correlated with maximum workload. Our results provide age- and sex-related limits of normal for RV contractile reserve as assessed by exercise stress echocardiography and demonstrate that RV systolic function indices (PASP, TAPSE, S', and TAPSE/PASP) correlate with maximum exercise capacity.

Determination of reference values for tricuspid annular plane systolic excursion in healthy Turkish children.

Objective:Tricuspid annular plane systolic excursion (TAPSE) is an echocardiographic measurement used for evaluating right ventricular systolic function. While established reference values of TAPSE exist for the adult population, only a limited number of studies have attempted to evaluate reference values for the pediatric population. The aim of the present study was to determine the reference values for TAPSE in healthy children in Turkey.Methods:A total of 765 healthy children aged between 0 and 18 years, all of whom were referred to our clinic with cardiac murmurs, were evaluated prospectively. Patients with no cardiac pathologies or other disorders were excluded from the study. The measurement of TAPSE was obtained using a 2D-guided M-mode technique with echocardiography, and the relationship between age and surface area with TAPSE was investigated. The statistical analysis was carried out using the SPSS 20.0 software package (SPSS Inc., Chicago, IL, USA, 2012).Results:The mean TAPSE value was found to be 19.56±5.54 mm, and no significant difference was identified between male and female children. TAPSE values showed a positive correlation with increasing age and surface area. The mean TAPSE value was 9.09±1.36 mm in newborns and 25.91±3.60 mm in the 13-18 years age group. A negative correlation was seen between TAPSE and heart rate.Conclusion:In the present study, the reference values for TAPSE in healthy Turkish children were presented in percentile tables and the corresponding z-scores were determined. These reference values may be useful in daily practice for the evaluation of right ventricular systolic function in children.

Right ventricular systolic function of patients with pneumoconiosis based on the evaluation of systolic displacement of tricuspid annulus

To determine the tricuspid annular plane systolic excursion (TAPSE) using M-mode echocardiography, and to evaluate the right ventricular systolic function in patients with pneumoconiosis. One hundred and eighty-three patients with pneumoconiosis were enrolled as subjects, and one hundred and ninety-nine healthy volunteers were used as controls. According to the types of ventilation dysfunction, patients were divided into four groups: normal type, obstructive type, restrictive type, and mixed type. In the apex four-chamber sections, the displacement of tricuspid annular plane on the right ventricular free wall side was measured from end-diastole to end-systole using M-mode echocardiography. The average TAPSE in the pneumoconiosis group was significantly lower than that in the control group (18.61 ± 3.08 vs 22.38 ± 3.03 mm, P < 0.01). Along with the progression of pneumoconiosis, the TAPSE values in patients with stage I, II, and III pneumoconiosis were significantly decreased compared with those in the control group (P < 0.01). The TAPSE values in patients diagnosed with normal, obstructive, restrictive, and mixed types of pneumoconiosis in pulmonary function tests were all significantly lower than those in the control group (P < 0.01). Among all patients, patients with mixed type of pneumoconiosis had the most significant reduction in the TAPSE. The TAPSE is substantially decreased in patients with pneumoconiosis and further decreased along with the progression of pneumoconiosis. Measurement of the TAPSE is an easy way to evaluate the right ventricular systolic function in patients with pneumoconiosis.

Tricuspid annular plane systolic excursion does not correlate with right ventricular ejection fraction in patients with hypoplastic left heart syndrome after Fontan palliation.

Tricuspid annular plane systolic excursion (TAPSE) reflects longitudinal myocardial shortening, the main component of right ventricular (RV) contraction in normal hearts. To date, TAPSE has not been extensively studied in patients with hypoplastic left heart syndrome (HLHS) and systemic RVs after Fontan palliation. This retrospective study investigated HLHS patients after Fontan with cardiac magnetic resonance (CMR) performed between 1 January 2010 and 1 August 2012 and transthoracic echocardiogram (TTE) performed within 6 months of CMR. The maximal apical displacement of the lateral tricuspid valve annulus was measured on CMR (using four-chamber cine images) and on TTE (using two-dimensional apical views). To create TTE-TAPSE z-scores, published reference data were used. Intra- and interobserver variability was tested with analysis of variance. Inter-technique agreement of TTE and CMR was tested with Bland-Altman analysis. In this study, 30 CMRs and TTEs from 29 patients were analyzed. The age at CMR was 14.1 ± 7.1 years, performed 11.9 ± 7.8 years after Fontan. For CMR-TAPSE, the intraclass correlation coefficients for inter- and intraobserver variability were 0.89 and 0.91, respectively. The TAPSE measurements were 0.57 ± 0.2 cm on CMR and 0.70 ± 0.2 cm on TTE (TTE-TAPSE z score, -8.7 ± 1.0). The mean difference in TAPSE between CMR and TTE was -0.13 cm [95 % confidence interval (CI) -0.21 to -0.05], with 95 % limits of agreement (-0.55 to 0.29 cm). The study showed no association between CMR-TAPSE and RVEF (R = 0.08; p = 0.67). In patients with HLHS after Fontan, TAPSE is reproducible on CMR and TTE, with good agreement between the two imaging methods. Diminished TAPSE suggests impaired longitudinal shortening in the systemic RV. However, TAPSE is not a surrogate for RVEF in this study population.

Accurate and reproducible measurements of right ventricular function in daily practice.

REFER TO THE PAGE 113-120 Traditionally right ventricle (RV) has been considered as a conduit or passive-dependent chamber mainly affected by loading conditions.1) Therefore, except for special situations such as pulmonary hypertension or complex congenital heart disease, main interest has been focused on left ventricle (LV).2) One of the reasons of eagerness for left sided parameters may come from complexity of RV morphology and different movement of RV during systole and diastole compared to LV.3) Therefore accurate measurement of RV volume and function in daily practice has lots of barriers to overcome. However, more and more evidences have suggested RV myocardial function itself has independent prognostic value not only in primary RV disease but also in LV diseases such as dilated cardiomyopathy or ischemic cardiomyopathy.4),5) Therefore need for reporting RV function is increasing in several disease entities. The causes of RV dysfunction in LV dysfunction can be explained by multiple mechanisms. Firstly, LV failure increase in pulmonary venous and arterial pressure, partly as a protective mechanism against pulmonary edema, then induce RV dysfunction; secondly, the same cardiomyopathy process may simultaneously affect the RV; thirdly, RV myocardial ischemia due to concomitant coronary artery disease; fourthly, ventricular inter-dependence due to septal dysfunction or limited pericardial compartment.3) RV dysfunction ultimately cause systemic venous congestion and reduced renal perfusion, thereby it deteriorates neurohormal status.6) Current gold standard for accurate measurements of RV systolic function is cardiac magnetic resonance imaging (CMR)-derived ejection fraction from stacked short axis cine images scanned with steady-state free precession sequence.7) The most advantage of CMR is accurate 3-dimensional measurements of RV systolic and diastolic volume without geometric assumption. However, CMR-derived RV volume measurement takes time and needs more learning period than conventional 2-dimensional echocardiographic measurements because of handling of RV inflow plane and outflow plane. Most of all, patients need undergo additional expensive exam. In this point of view easy and reproducible way of measurements are deadly needed with conventional echocardiography. Currently, RV fractional area change, tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular velocity are widely used.8) However, RV fractional area change has limitations in terms of poor endocardial border delineation and negligence of geometric change. As RV changes from eccentric-crescent shape to oval shape as increase in preload or afterload, this limitation might be augmented in really sick RV. Easy and practical method is measurement of TAPSE or tricuspid annular velocity by tissue Doppler imaging based on concept that the RV long axis fiber movements mainly contribute to systolic function. But these two parameters are largely affected by tethering motion of adjacent myocardium. Speckle tracking echocardiography or velocity vector imaging can provide index of longitudinal myocardial deformation by escaping tethering effects.9),10) In this issue, Park et al.11) introduced global longitudinal strain of RV with validation by comparison with CMR-derived RV ejection fraction. One of the interesting findings of the study is that the investigators used vendor independent analyzing software, velocity vector imaging. With applying this program, RV strain can be measured during every conventional echocardiography examination. Algorithm of the tracking system has advantages for measuring longitudinal strain in thin walled myocardium such as RV or left atrium. But, in this study, the authors skipped assessment of inter-vendor measurements variability with an analyzing software. Although the authors commented in the limitation, this step should be done and clarified before using these results in daily practice, because we need specific cut-off value for RV dysfunction which can be used in any vendors like ejection fraction. Regarding prediction of outcome, RV strain measured by vendor independent program should show incremental value to left sided parameters which is more reproducible and more widely used in daily practice. On the point of view, if this study could have included LV strain, the result would be more solid. Inclusion of EuroScore II12) as a compact covariate for multivariable analysis seems reasonable in the situation of small number of study end-points. Despite some limitations, the study results can provide new way of accurate and convenient RV functional measurements in busy echo-lab.

Tricuspid annular plane systolic excursion (TAPSE) revisited using CMR

Summary This observational pilot project was performed as background to eventually create a rapid, automated and accurate assessment of RV systolic function in variable clinical subgroups. We propose new parameters that characterize the global systolic function of the right ventricle with a simple linear measurement. Background The tricuspid annular plane systolic excursion (TAPSE), which has been used for over a quarter century as a quick estimate of RV systolic function, was revisited using CMR. It shows good correlation with invasive hemodynamics. MRI is the current gold standard to assess the volumes and anatomy of the heart and we can measure TAPSE more precisely with cardiac MRI to accurately detect any current problems TAPSE measurements may suffer from.

Tricuspid Annular Plane Systolic Excursion Is a Robust Outcome Measure in Systemic Sclerosis-associated Pulmonary Arterial Hypertension

The tricuspid annular plane systolic excursion (TAPSE) strongly reflects right ventricular (RV) function and predicts survival in idiopathic pulmonary arterial hypertension (PAH). But its role in systemic sclerosis (SSc)-associated PAH has not been established. Our objective was to validate the TAPSE in the assessment of RV function and prediction of survival in SSc-PAH. Fifty consecutive patients with SSc-PAH who underwent echocardiography with TAPSE measurement within 1 h of clinically indicated right heart catheterization were followed prospectively. The relationship between TAPSE and measures of RV function and measures of survival was assessed. The majority of the cohort were women in New York Heart Association class III/IV with severe PAH (mean cardiac index 2.4 ± 0.8 l/min/m(2)). RV function was significantly impaired (mean cardiac index 2.1 ± 0.7 vs 2.9 ± 0.8 l/min/m(2); p < 0.01) and RV afterload was significantly greater (mean pulmonary vascular resistance 11.1 ± 5.1 vs 5.8 ± 2.5 Wood units; p < 0.01) in subjects with a TAPSE ≤ 1.7 cm. The proportion surviving in the low TAPSE group was significantly lower [0.56 (95% CI 0.37-0.71) and 0.46 (95% CI 0.28-0.62) vs 0.87 (95% CI 0.55-0.96) and 0.79 (95% CI 0.49-0.93), 1- and 2-year survival, respectively]. TAPSE ≤ 1.7 cm conferred a nearly 4-fold increased risk of death (HR 3.81, 95% CI 1.31-11.1, p < 0.01). TAPSE is a robust measure of RV function and strongly predicts survival in patients with PAH-SSc. Future studies are needed to identify the responsiveness of TAPSE to PAH-specific therapy and to assess its diagnostic utility in PAH-SSc.