Comparison of tricuspid annular plane systolic excursion with fractional area change for the evaluation of right ventricular systolic function: a meta-analysis

Abstract

BackgroundAccurate determination of right ventricular ejection fraction (RVEF) is challenging because of the unique geometry of the right ventricle. Tricuspidannular plane systolic excursion (TAPSE) and fractional area change (FAC) are commonly used echocardiographic quantitative estimates of RV function. Cardiac MRI (CMRI) has emerged as the gold standard for assessment of RVEF. We sought to summarise the available data on correlation of TAPSE and FAC with CMRI-derived RVEF and to compare their accuracy.MethodsWe searched PubMed, EMBASE, Web of Science, CINAHL, ClinicalTrials.gov and the Cochrane Library databases for studies that assessed the correlation of TAPSE or FAC with CMRI-derived RVEF. Data from each study selected were pooled and analysed to compare the correlation coefficient of TAPSE and FAC with CMRI-derived RVEF. Subgroup analysis was performed on patients with pulmonary hypertension.ResultsAnalysis of data from 17 studies with a total of 1280 patients revealed that FAC had a higher correlation with CMRI-derived RVEF compared with TAPSE (0.56vs0.40, P=0.018). In patients with pulmonary hypertension, there was no statistical difference in the mean correlation coefficient of FAC and TAPSE to CMR (0.57vs0.46, P=0.16).ConclusionsFAC provides a more accurate estimate of RV systolic function (RVSF) compared with TAPSE. Adoption of FAC as a routine tool for the assessment of RVSF should be considered, especially since it is also an independent predictor of morbidity and mortality. Further studies will be needed to compare other methods of echocardiographic measurement of RV function.

Cardiopulmonary dysfunction in perinatally HIV‐infected South African adolescents on antiretroviral therapy: baseline findings from the Cape Town Adolescent Antiretroviral Cohort

“…TAPSE has been found to be highly specific and easy method to estimate the right ventricular ejection fraction . FAC has better correlation with cardiac MRI‐derived RV systolic dysfunction .…”

Echocardiographic Assessment of the Right Ventricle–State of the Art

“…Reduced FAC has been shown to be an independent predictor of heart failure, sudden cardiac death, stroke and mortality in patients suffering pulmonary embolism [14]. Meta-analysis suggests it is more accurate as a measure of RV function than tricuspid annular plane systolic excursion (TAPSE), although care needs to be taken to acquire good views [15]. Its primary limitation is the requirement of good endocardial definition, which is often difficult, particularly in the heavily trabeculated free wall [16].…”

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

“…Current echocardiographic guidelines recommend combining various echocardiographic parameters to assess RV function [21]. Clinically used parameters include the fractional area change (FAC), which is a surrogate of ejection fraction and correlates with RV ejection fraction estimated by cardiac magnetic resonance better than other parameters [19,22,23].…”

“…RV FAC is considered a global systolic parameter [17] as it provides information on the percentage of change in RV area from end-diastole to endsystole, which results from the combination of longitudinal and radial (transverse) shortening [22]. RV FAC has some advantages compared to other RV echocardiographic parameters such as tricuspid annular plane systolic excursion (TAPSE) by m-Mode [22] and tricuspid annular peak systolic velocity (S') by tissue Doppler imaging [24]. TAPSE and S', with available fetal nomograms, reflect RV longitudinal systolic function, which does not incorporate the transverse motion of the free wall toward the septum.…”