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

Abstract

BACKGROUNDTricuspid 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).METHODSWe 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.RESULTSm-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.CONCLUSIONSm-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.

Assessment of Right Ventricular Systolic Function: Conventional Methods and Modified Tricuspid Annular Plane Systolic Excursion

“…Based on intraobserver analysis, the authors' data showed that all parameters were reproducible for the validated data. In conclusion, Dhawan et al13) showed that m-TAPSE was correlated with both conventional TAPSE and RV-FAC. RV-FAC was validated to be a strong estimate parameter of RV function 8)…”

“…To the best of my knowledge, Morita et al9) previously reported that m-TAPSE was validated as having a good correlation to RV-FAC and could be considered an eligible parameter to evaluate RV systolic function. Beyond the previous study, Dhawan et al13) suggested that m-TAPSE for evaluating RV function is possibly useful in a busy intraoperative setting and is not dependent on image quality by “prospectively” comparing m-TAPSE with three parameters: m-TAPSE on TEE, TAPSE measured by TTE, and RV-FAC on TEE. One of the strengths of this study is presentation of the data from TTE and TEE simultaneously measured and recorded post-induction.…”

“…In this issue of the journal, Dhawan et al13) investigated the usefulness of m-TAPSE in assessing RV systolic function and compared m-TAPSE with both TAPSE (the most commonly used parameter) and RV-FAC (the near-gold standard 2D echocardiography parameter). A prospective observational study was performed on 125 patients undergoing coronary artery bypass graft surgery.…”

Management of perioperative acute massive pulmonary embolism: A case series

“…Tricuspid annular plane systolic excursion (TAPSE) is one of the verified methods for assessing RV systolic function. In TEE, the modified TAPSE can be considered an alternative method for evaluating the RV systolic function, especially at the busy operating room 14 …”

“…In TEE, the modified TAPSE can be considered an alternative method for evaluating the RV systolic function, especially at the busy operating room. 14 If an accurate diagnosis has been made, veno-arterial ECMO may be helpful for patients with hemodynamic collapse. It may be possible to prevent end-organ damage, thereby improving patients' survival.…”