Abstract 17919: Tricuspid Annulus Systolic Excursion has Only Limited Reliability for the Assessment of Right Ventricular Function in Patients with Pulmonary Hypertension
Objective: The complex right ventricular (RV) geometry and load dependency of indices used to quantify its function make RV assessments very challenging. Because accurate and reproducible RVEF measurements are difficult, there is increasing tendency to use for evaluations of RV systolic function the more easy and reproducibly measurable tricuspid annular plane systolic excursion (TAPSE). However, TAPSE correlates only moderately with RVEF as measured by radionuclide angiography and both its load dependency and its relation to tricuspid regurgitation (TR) are barely known. We assessed this issue in order to provide more information on clinical utility of TAPSE.
Methods: We evaluated all consecutive patients with chronic pre-capillary pulmonary hypertension referred for therapy since 1/2005. Exclusion criteria were atrial fibrillation, LV end-diastolic and pressure >15 mmHg, LVEF < 50% and congenital systemic to pulmonary shunts. TAPSE and tricuspid annulus peak systolic velocity (TAPSm) measured at the RV free wall were tested for relationship with pulmonary arterial pressure (PAP), TR, right atrial pressure (RAP), cardiac output (CO), exercise tolerance and patient outcome.
Results: The 52 evaluated patients showed a negative correlation between TAPSE and systolic PAP but no correlation between TAPSE and either RV size or short/long axis ratio and also no correlation between TAPSE and RAP. For the subgroup (n = 19) without relevant TR (grade < II) the correlation coefficient between TAPSE and systolic PAP was higher and there was also a negative correlation between TAPSE and both the end-diastolic RV diameter and the RV short/long axis ratio (p<0.01). TAPSm also showed a negative correlation with systolic PAP in the 52 patients but appeared less affected by TR and also showed a significant correlation with RAP (p<0.01). Either CO or peak oxygen uptake correlated with TAPSE. TAPSm reduction of ≥ 15% without simultaneous PAP increase showed 87.5% predictive value for 1 year mortality without transplantation.
Conclusion: TAPSE is not reliable for assessment of RV function in patients with TR. TAPSm, which appears less affected by TR, can be useful for evaluation of RV function and prediction of patients' outcome if the afterload (PAP) is also taken into account.
- © 2010 by American Heart Association, Inc.