Abstract 6170: Tricuspid Annular Plane Systolic Excursion Predicts Invasive Hemodynamic Markers of Right Ventricular Function in Pulmonary Hypertension
Right ventricular (RV) systolic function is an important prognostic factor in pulmonary hypertension. Its echocardiographic assessment is limited by RV geometry and poor endocardial definition. Tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RVFAC) are used as echo measures of RV systolic function. We tested the hypothesis that TAPSE and RVFAC correlate with invasive measurements of cardiac index, dP/dt max and dP/dt max normalized to instantaneous pressure. (dP/dtmax/IP). 15 consecutive patients with pulmonary hypertension and clinical indication for right heart catheterization were prospectively evaluated using high fidelity micromanometry in addition to traditional PA catheterization. Patients underwent transthoracic echo immediately following catheterization. TAPSE was measured by M-mode echo as the mean displacement (cm) of the tricuspid annular plane towards the RV apex from end diastole to end systole. RVFAC was measured as the percent change in RV area from end diastole to end systole as measured in the apical four chamber view. In this cohort, TAPSE correlates with cardiac index p≪26>0.046) and inversely with mean pulmonary artery pressure (p = 0.001). The strongest correlation was with dP/dtmax/IP (r = 0.79; p<0.001). RVFAC did not correlate with any invasive hemodynamic measurements. TAPSE correlates strongly with invasive indices of RV systolic function, best with the load-independent index dP/dtmax/IP. RVFAC was not of use in evaluating RV systolic function. As pulmonary hypertension generates high afterload for the RV, correlation with load-independent indices is a particularly desirable characteristic and more directly reflects myocyte contractility. TAPSE is an excellent marker of right ventricular function.