J Cardiovasc Ultrasound.  2012 Dec;20(4):181-188. 10.4250/jcu.2012.20.4.181.

Evaluation of Right Ventricular Systolic Function by the Analysis of Tricuspid Annular Motion in Patients with Acute Pulmonary Embolism

• Park JH
• Kim JH
• Lee JH
• Choi SW
• Jeong JO
• Seong IW

• KMID: 2177405
• DOI: http://doi.org/10.4250/jcu.2012.20.4.181

Abstract

BACKGROUND
Measurement of right ventricular (RV) systolic function is important for patients with acute pulmonary embolism (PE). However, assessment of RV function is a challenge due to its complex anatomy. We measured RV systolic function with analysis of tricuspid annular motion in acute PE patients.
METHODS
From August 2007 to May 2011, all consecutive PE patients were prospectively included. Tricuspid annular motion was analyzed with tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TASV).
RESULTS
We analyzed total 50 patients (38 females, 68 +/- 14 years). Mean RV fractional area change (RVFAC) was 26.2 +/- 10.8%; RV Tei index 0.78 +/- 0.35; TR Vmax 3.8 +/- 0.5 m/sec; pulmonary vascular resistance (PVR) 3.5 +/- 1.2 WU. TAPSE was 16 +/- 4 mm and TASV was 11.7 +/- 4.0 cm/sec. TAPSE showed significant correlations with RVFAC (r = 0.841, p < 0.001), RV Tei index (r = -0.347, p = 0.018), Log B-type natriuretic peptide (BNP) (r = -0.634, p < 0.001) and PVR (r = -0.635, p < 0.001). TASV also revealed significant correlations with RVFAC (r = 0.605, p < 0.001), RV Tei index (r = -0.380, p = 0.009), LogBNP (r = -0.477, p = 0.001) and PVR (r = -0.483, p = 0.001). The best cutoff of TAPSE for detection of RV systolic dysfunction (defined as RVFAC < 35%) was 1.75 cm [Areas under the curve (AUC) = 0.96, p < 0.001] with a sensitivity of 87% and specificity 91%. The best cutoff for TASV was 13.8 cm/sec (AUC = 0.90, p < 0.001), sensitivity 86% and specificity 78%. However, there was no statistical significance in the detection of RV dysfunction (difference = 0.07, 95% CI = -0.21-0.17, p = 0.130) between TAPSE and TASV.
CONCLUSION
TAPSE and TASV showed significant correlations with conventional echocardiographic parameters of RV function and LogBNP value. These values can be used to detect RV systolic dysfunction more easily in patients with acute PE.

Keyword

Right ventricle; Pulmonary embolism; Echocardiography; Tricuspid annulus

MeSH Terms

Echocardiography
Female
Heart Ventricles
Humans
Natriuretic Peptide, Brain
Prospective Studies
Pulmonary Embolism
Sensitivity and Specificity
Vascular Resistance
Natriuretic Peptide, Brain

Figure

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  Fig. 1 Correlations between tricuspid annular plane systolic excursion (TAPSE) and echocardiographic parameters and serum B-natriuretic peptide (BNP) level. TAPSE shows good correlations with RV fractional area change (RVFAC, A), RV Tei index (B), pulmonary vascular resistance (PVR, C) and LogBNP (D).

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  Fig. 2 Correlations between tricuspid annular systolic velocity (TASV) and echocardiographic parameters and serum B-natriuretic peptide (BNP) level. TASV shows good correlations with RV fractional area change (RVFAC, A), RV Tei index (B), pulmonary vascular resistance (PVR, C) and LogBNP (D).

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  Fig. 3 Receiver operating curve analysis in the detection of right ventricular (RV) systolic dysfunction (determined by RV fractional area change < 35%). Tricuspid annular plane systolic excursion (TAPSE) shows larger area under the curve than tricuspid annular systolic velocity (TASV). However, there is no statistical significance (difference = 0.07, 95% CI: -0.02-0.17, p = 0.130) in the detection of RV systolic dysfunction. AUC: areas under the curve, CI: confidential interval.

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  Fig. 4 Survival curves by Kaplan-Meier analysis. There was no statistical significance in the groups of right ventricular systolic dysfunction by tricuspid annular plane systolic excursion (TAPSE, A) or tricuspid annular systolic velocity (TASV, B). p value was calculated by log-rank test.

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