J Cardiovasc Imaging.  2019 Jan;27(1):24-33. 10.4250/jcvi.2019.27.e8.

Modified Tricuspid Annular Plane Systolic Excursion for Assessment of Right Ventricular Systolic Function

• Dhawan I
• Makhija N
• Choudhury
• Choudhury

• KMID: 2433761
• DOI: http://doi.org/10.4250/jcvi.2019.27.e8

Abstract

BACKGROUND
Tricuspid annular plane systolic excursion (TAPSE) has become a popular tool for assessing right ventricular (RV) systolic function because of its ease of application. TAPSE using transesophageal echocardiography (TEE) is limited by alignment with the lateral wall of the RV. Modified TAPSE (m-TAPSE) is a novel method for measuring TAPSE. m-TAPSE is the difference in the "˜apical to lateral tricuspid annulus distance' during diastole and systole. The aim of the present study was to compare prospectively m-TAPSE with the most commonly used parameter TAPSE and near-gold standard 2D echocardiographic parameter RV fractional area change (RV FAC).
METHODS
We conducted a prospective observational study of 125 consecutive patients undergoing coronary artery bypass graft surgery in a single tertiary care center. Post-anesthetic induction TAPSE was recorded using transthoracic echocardiography (TTE). m-TAPSE was recorded using TEE in the mid-esophageal four-chamber view. RV FAC was also assessed using TEE. m-TAPSE < 16 mm, TAPSE < 16 mm and RV FAC < 35% were taken as cut-offs for RV systolic dysfunction. Correlations were assessed using the Pearson correlation coefficient. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using 2 × 2 cross table.
RESULTS
m-TAPSE was significantly correlated with TAPSE (r = 0.797, p < 0.001). Similarly, a significant correlation was observed between m-TAPSE and RV FAC (r = 0.602, p < 0.001). The sensitivity, specificity, PPV, NPV, and accuracy of m-TAPSE were 100%, 98.3%, 80%, 100% and 98.4%, respectively.
CONCLUSIONS
m-TAPSE correlated well with both RV FAC and TAPSE. Therefore, m-TAPSE can be considered an easily measurable alternative parameter for evaluating RV systolic function in a busy intraoperative setting.

Keyword

Modified tricuspid annular plane systolic excursion; Tricuspid annular plane systolic excursion; Right ventricular fractional area change; Right ventricular function

MeSH Terms

Coronary Artery Bypass
Diastole
Echocardiography
Echocardiography, Transesophageal
Humans
Methods
Observational Study
Prospective Studies
Sensitivity and Specificity
Systole
Tertiary Care Centers
Transplants
Ventricular Function, Right

Figure

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  Figure 1 Measurement of TAPSE. In this figure TAPSE = 2.33 cm. TAPSE: tricuspid annular plane systolic excursion.

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  Figure 2 Measurement of m-TAPSE. m-TAPSE was measured as the difference in ‘apical to lateral tricuspid annulus distance’ during systole (A) showing the minimum dimension and diastole (B) showing the maximum dimension on the mid-esophageal four-chamber view. In this figure, m-TAPSE was 9.03-6.97 = 2.06 cm. m-TAPSE: modified tricuspid annular plane systolic excursion.

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  Figure 3 Mid-esophageal four-chamber view demonstrating RV FAC in diastole (A) and in systole (B). Trabeculation, tricuspid leaflets, and chordae are included in the chamber. In this figure RV FAC = 21.4 - 13.6 / 21.4 × 100 = 36.44%. FAC: fractional area change, RV: right ventricular.

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  Figure 4 Bland-Altman plot of differences (y-axis) and average of 2 independent observers (x-axis) for m-TAPSE assessment (inter observer variability). m-TAPSE: modified TAPSE, TAPSE: tricuspid annular plane systolic excursion.

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  Figure 5 Correlation of TAPSE with m-TAPSE for RV systolic function assessment (correlation coefficient r = 0.797; p < 0.001). m-TAPSE: modified TAPSE, RV: right ventricular, TAPSE: tricuspid annular plane systolic excursion.

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  Figure 6 Correlation of m-TAPSE with RV FAC for RV systolic function assessment (correlation coefficient r = 0.602; p < 0.001). FAC: fractional area change, m-TAPSE: modified tricuspid annular plane systolic excursion, RV: right ventricular.

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  Figure 7 Bland-Altman plot of differences between average values of m-TAPSE and TAPSE. m-TAPSE: modified TAPSE, TAPSE: tricuspid annular plane systolic excursion.

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